On March 16, members met and discussed multiple options to generate the final $600,000 in cost-sharing needed to close a $5.5 million shortfall in the District’s health plan budget. After making earlier recommendations (detailed in the attached infographic), today’s discussion focused on potential, small changes in copays or premiums.
After discussion and votes to narrow a field of six possible cost-sharing options, members voted to change pharmacy, emergency room and urgent care co-pays, but to leave current office co-pays unchanged and to protect premiums at their current levels. This is the first time that co-pays have changed since 2012. The changes include:
- Pharmacy co-pays change from $24 to $30 for Preferred Brand and from $34 to $40 for Brand drugs, with generic co-pays remaining $9 for a 30-day supply.
- Emergency Room co-pays change from $150 to $200, if a covered employee or their dependent visits the ER but is not admitted. If admitted, there is no ER co-pay.
- Urgent Care co-pays will change from $35 to $40 per visit.
- Premiums DO NOT change.