WSHA contacted the Office of the Insurance Commissioner (OIC) regarding a change in benefits which could create unexpected out of pocket costs for patients. Regence and its affiliated health plans intend to apply a benefit change for new individual plan enrollees and renewals in 2024. Under the change, certain provider-administered drugs will not be covered unless the hospital or provider signed a separate contract for the drugs with Regence’s specialty pharmacy partner, even if the drug is provided and administered by a participating provider or hospital. WSHA is concerned patients will face unexpected costs as they would have little ability to know in advance if their provider had a separate contract with the pharmacy partner or if their treatment could include drugs that would be subject to the benefit change.
OIC advised WSHA it will work with Regence to ensure it is implemented in a manner to ensure patients do not face unexpected costs. WSHA appreciates OIC’s willingness to provide oversight, which we believe will include ensuring advance enrollee communication and network adequacy. If hospitals or providers identify issues with Regence’s implementation, they should contact OIC at 800-562-6900. OIC often relies on direct provider and consumer complaints to determine areas of focus. (Andrew Busz, andrewb@wsha.org)
