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Portico Holds 2018 Health Contribution Rates to Last Year’s Low Increase, Looks to Expand Personalized Support

Aug. 07, 2017

Against a national backdrop of rapidly rising prescription drug prices and legislative uncertainty, Portico is holding ELCA Health Plan costs to single-digit increases for 2018. Contribution rates will increase by the same percentages as last year, and, other than brand-name prescription drugs, member deductibles, out-of-pocket maximums, and wellness dollars will again remain unchanged. Portico’s board of trustees voted to approve Portico’s recommendations for 2018 at its Aug. 3 – 4 meeting in Minneapolis.

The Rev. Jeff Thiemann, Portico’s President and CEO, called the 5% baseline health increase for sponsoring employers good news in light of nationwide 2018 medical trends projected at 6.5% or higher.* “Of course, we know an increase of any amount can be challenging for congregations that sponsor their leaders and staff in the ELCA benefit program. In today’s shifting health care landscape, we’re pleased to hold rates to the same increase as last year, which was the lowest since 2013,” he said.

Sponsoring employers can estimate their 2018 costs using their Custom Comparison Report on EmployerLink starting in mid-August. See below for a summary of contribution rate changes.
 

Taking a More Personalized Approach to Supporting Members

“We worked hard to minimize changes for plan members, recognizing that many are still getting used to working with our Portico Care Coordinators by Quantum Health,” Thiemann said. Portico added Care Coordinators in Jan. 2017 to help ELCA-Primary members navigate today’s complex health care system and get the best possible care at the right price. According to Thiemann, more than two-thirds of members have already used the service. “Members can count on this team of experts to remain by their side in 2018.”

In June 2017, Portico focused on the growing prevalence of diabetes by inviting ELCA-Primary members with type 1 or type 2 diabetes to enroll in the Livongo for Diabetes Program. Members can receive a blood glucose meter, unlimited test strips, and personalized coaching to help make living with diabetes easier. According to a recent year-long study by Livongo, participants in the program sustained a 0.9% decrease in high blood glucose, a substantial improvement that reduces the likelihood of long-term complications such as kidney failure, blindness, heart attacks, and strokes. Participants also saw a 5.8% decrease in annual health care costs.

Thiemann credits anticipated savings from Care Coordinators and Livongo for helping Portico repeat last year’s low contribution rate increase in 2018. As part of the ongoing wellness reformation, Portico is exploring additional programs for 2018 to help members better understand their health risks, and manage their health conditions more effectively.
 

Seeking Additional Savings Through Generic Prescription Drugs

One exception to the status quo for members is the amount they’ll pay for brand-name prescription drugs in 2018. The ELCA’s overall prescription drug spending grew nearly three times faster than medical claims last year. To encourage more members to choose lower-cost generic drugs when possible, Portico will introduce coinsurance for brand-name drugs under the ELCA-Primary Platinum+, Gold+, and ELCA Medicare-Primary options. Members will continue to pay the same copayments for generic drugs, but for brand-name drugs, members will pay a percentage of the drug’s full price, subject to a minimum and maximum amount per prescription. See details below.

“This change preserves the ability of members and their doctors to determine the right medication for their situation. When it’s a brand-name drug, we’re asking members to pay a portion that more accurately reflects its higher cost,” said Josh Smith, Portico’s Director of Health Products.

“We’re grateful so many members already choose generic drugs, and we hope to see more make this choice. We also recognize that in some cases a brand-name drug is the best option, or the only option. That’s why we’re capping the coinsurance with a maximum amount.” Currently 85.5% of ELCA Health Plan prescriptions are filled with generic drugs. Portico’s prescription drug administrator, Express Scripts, sees potential for this number to grow to 90% and estimates that every 1% shift from brand-name to generic utilization would save the ELCA about $1 million per year.

Members with ELCA-Primary health benefits are encouraged to call Portico Care Coordinators at 877.851.5656 to ask their prescription drug questions and get help navigating their options before the brand-name drug change takes effect Jan. 1, 2018.
 

2018 Contribution Changes

Sponsoring Employers

For the second year in a row, health contribution rates will increase by 5% for all options. Contributions also increase about 2% annually for most plan members due to age.

No changes to disability, basic group life insurance, retiree support, and minimum retirement contribution rates. Sponsoring employers can find details in their Custom Comparison Report on EmployerLink.

Note: Because rates are a percent of defined compensation, contributions also increase when a member’s salary increases.

Members Continuing ELCA-Primary Health Coverage

Contribution rates will increase by 5% for all options. Contributions also increase about 2% annually for most plan members due to age.

Members Continuing ELCA Medicare-Primary Health Coverage

Contribution rates will increase by 7.5% for all options: from $414 to $445 per month for the Premium option; $366 to $393 per month for Standard; and $350 to $376 per month for Economy.
 

2018 Prescription Drug Changes

Members With:
ELCA-Primary Platinum+ or Gold+
ELCA Medicare-Primary
2017 2018

Generics: No changes. Copayments will remain the same.

31-day supply (retail):

90-day supply (home delivery):

$10

$20

$10

$20

Preferred1 brand-name: 20% coinsurance will replace copayments, subject to a minimum2 and maximum3 amount per prescription.

31-day supply (retail):

90-day supply (home delivery):

$47

$100

$45 – $75

$100 – $175

Non-preferred1 brand-name: 35% coinsurance will replace copayments, subject to a minimum2 and maximum3 amount per prescription

31-day supply (retail):

90-day supply (home delivery):

$74

$160

$75 – $150

$175 – $250

1The ELCA Health Plan uses the Express Scripts National Preferred Formulary (list of preferred drugs). Non-preferred drugs are typically more expensive than their preferred alternatives or new to the marketplace.

2The member will pay the Express Scripts negotiated rate for the drug if it’s less than the minimum.

3The member will pay more than the maximum, up to the full cost of the drug, if an equivalent generic drug is available and the member chooses the brand-name drug, or if the drug is not on the formulary.

Members With:
ELCA-Primary Silver+ or Bronze+
2017 2018

No changes. These are considered high-deductible health plan options. Members will pay the full cost for prescription drugs until their deductible is met.

*Projected by PwC’s Health Research Institute.

A Livongo study presented in June 2017 at the 77th Annual American Diabetes Association’s Scientific Sessions revealed a reduction in mean HbA1c from 7.8% to 6.9% for 4,346 Livongo program participants over one year. Health care savings are based on medical claims analysis of 3,474 Livongo participants vs. 12,065 people with diabetes not enrolled in Livongo over the same timeframe.


About Portico Benefit Services
A ministry of the ELCA, Portico Benefit Services provides health, retirement, disability, and survivor benefits and related services for approximately 50,000 active and retired ELCA rostered ministers, lay employees, and their families. For more information, contact Portico at 800.352.2876.