Retired workers petitioned a federal judge to intervene when the City of Cincinnati put forth plans to remove erectile dysfunction medications from their health benefits in June 2019. The city planned to make the cut to health benefits in order to save $425,000 per year. The recent debate has caused many to question whose responsibility it is to cover medications deemed as “lifestyle drugs.”
The City’s Case
The Cincinnati Retirement System projected retiree health benefits to reach $34 million for the 2019 fiscal year. Prescription medication coverage was estimated to account for half of the expenditures. City Manager, Patrick Duhaney, commented on the dramatic increase of prescription medication rates as an alarming trend anticipated to rise with each year.
The city announced its plan to revoke coverage of erectile dysfunction medications from retiree health plans, which would reduce spending by $425,000. However, they noted they would continue to provide prescription coverage for individuals requiring the drug for treatment of a medical condition, such as an enlarged prostate or prostate cancer. The city chose to focus on erectile dysfunction medications to reduce health costs due to the name brand medications being among the most expensive therapeutic medications currently provided for retirees.
The city has not covered prescription medications for erectile dysfunction for current employees since 2018. Additional methods of reducing health benefit costs included requiring retirees to receive prescriptions through mail delivery and adding “quantity limits step therapy and prior authorizations” to the coverage process. The city hopes to save hundreds of thousands of dollars through the implementation of this new plan.
The Case of the Workers
Retirees were aware of the high costs associated with health benefits but requested being provided with quality care promised upon retirement. A 2015 consent agreement between the city and workers prohibited the reduction of benefits to workers in the future. Retirees motioned that the elimination of erectile dysfunction medications violated the 2015 consent agreement.
The city and retired workers spent months negotiating an agreement to settle an impending pension crisis in 2015. The 2015 consent agreement resulted in the allowance of the city to move $200 million from the city health care fund in an effort to directly support the city pension fund. The city agreed not to make significant changes to health benefits without approval, which included making any reductions in benefits.
“Removing a drug – any drug – ‘from coverage’ is by definition a ‘reduction’ in benefits,” attorney Peter O’Shea wrote in his motion to the District Court.
Moving Forward
The city discontinued coverage of erectile dysfunction medications for those using the medications as a “lifestyle medication” in July. The city argued they should be allowed to make routine changes to health benefits without U.S. District Court oversight. They also announced in September that they plan to transition their system from a self-insured plan to a Medicare Advantage Plan, effective January 1, 2020.
Retired city workers are now requesting the city pay $123,000 in legal fees accrued while fighting for coverage of erectile dysfunction medications such as Viagra and Cialis. The bills spanned from January 2019 to November 2019 and lawyers anticipate the cost of legal counsel to increase as the dispute widens.
Prescription medication costs continue to rise on average, but generic erectile dysfunction medications are now being offered at significantly lower out-of-pocket cost. Those wishing to conveniently and discreetly order erectile dysfunction or sexual health medications can do so online at eDrugstore.com today.
Shelby is a public health professional with research and field experience in sexual and reproductive health. She holds a Master of Public Health (MPH) and is a Certified Health Education Specialist (CHES).