Despite a warning letter from the city, Buffalo workers and retirees will not see any changes to their over-the-counter prescription drug coverage, after all.
But the effort to reverse another change that limits the quantity of prescribed medications is still being worked on.
When the Human Resources Department discovered that some plan members were using their pharmacy benefit cards to get over-the-counter medications it said should not have been covered, city officials at first said the medications would no longer be provided beginning Jan. 1.
But that changed after South Common Council Member Christopher P. Scanlon brought up the matter in a recent Council meeting after hearing from some upset employees.
When CVS Pharmacy became the city's new pharmacy benefits provider last September, "it was made clear to us there was going to be no change in what was covered," Scanlon said.
Now, the city says over-the-counter medications – which can cost more without a prescription – will be covered. About 540 members use prescriptions for over-the-counter drugs for allergies and about 100 for gastrointestinal issues, officials said. The annual cost for that is about $43,000, said Parking Commissioner Kevin J. Helfer, a member of Mayor Byron W. Brown's fiscal subcabinet.
"The city will be informing CVS that we want the OTC prescriptions that were historically covered to continue being covered as they were in the past," Helfer said, adding that the city is self-insured.
When asked why the city reversed course, if there was a misstep in communication between the city and CVS, city spokesman Michael J. DeGeorge responded, "Yes, there was a misstep, and it has since been rectified."
But another matter still needs to be reconciled, Scanlon said, involving employees whose medications were prescribed as daily dosages for 365 days. The problem is that CVS was capping the quantity at 90 days, for instance, for the whole year, he said.
Scanlon, who met Thursday with Helfer and Human Resources Commissioner Gladys Herndon-Hill, said he is waiting to hear back on how that issue will be resolved.
"I don't care if it's 30 days at a time, 60 days at a time, but if they need it daily, they need to receive it," Scanlon said.
Meanwhile, the over-the-counter drugs will continue to be covered.
"The city said there wouldn't be any changes, and there won't be any changes," DeGeorge said Thursday.
That statement was very different from the one Human Resources relayed to plan members in a Dec. 20, 2019, letter from the city's Division of Compensation and Benefits, which handles 12,047 of the city's active and retired employees and their covered dependents.
"It has come to the attention of the City of Buffalo Division of Compensation and Benefits that plan members have been using their pharmacy benefit card in order to obtain over-the-counter medications that should not have been covered," the letter said. "In light of this discovery, please be advised that effective January 1, 2020, over-the-counter medications will no longer be provided under your pharmacy benefit."
Scanlon had invited a representative from the city's Human Resources Department to attend Tuesday's Finance Committee meeting to discuss the pharmacy benefits plan.
"My office just received a number of complaints about the new prescription provider and some potential changes that may have been taking place, and we just want to have a conversation, get to the bottom of it and make sure that nothing's negatively impacting any of the City of Buffalo employees and that all prescriptions are being covered the way they should be," Scanlon said during last week's Council meeting. "We're just looking to have a conversation next week in committee."
Now that conversation may not be necessary, Scanlon said Thursday.
"Hopefully, this is an issue that was averted," he said after meeting with administration officials. "We will have conversations between now and Tuesday, and based on those conversations it may be unnecessary to have Human Resources attend the Finance Committee meeting."
After extensive talks, the Council approved a contract with CVS to be the city's pharmacy benefits manager – replacing Express Scripts – on Sept. 3, 2019, with the contract taking effect Sept. 15.