PEIA Director: Agency Making Strides In Controlling Prescription Costs, Advancing Wellness 

West Virginia’s Public Employees Insurance Agency (PEIA) Director Brian Cunningham said he’s working on several fronts to reduce the latest round of premium increases that were approved last week. 

Speaking to the interim Joint Standing Committee on Insurance and PEIA on Monday, Cunningham said the agency is seeking some initial prescription cost reducing opportunities around diabetes, weight management and migraine medications. 

“We’re taking an incremental approach to comparative effectiveness to minimize provider and member disruption,” Cunningham said.

Cunningham told lawmakers PEIA is leveraging the 340B Drug Pricing Program. He explained it allows Federally Qualified Health Centers (FQHC) to buy medications at a savings. 

“(Getting entities such as) disproportionate share hospitals, critical access hospitals, community behavioral health centers, and other covered entities to buy at a very low cost,” Cunningham said. “For example, an AWP (Average Wholesale Price) at minus 50, 60, and even 70 percent in some cases, 

Cunningham said the agency is also consolidating a number of wellness programs under a cost saving single management structure with one vendor. 

“We’re targeting diabetes, weight management and behavioral health,” Cunningham said. “All problems that we face here in the state of West Virginia.”

Cunningham said a number of expanding PEIA online wellness programs also target weight loss and controlling diabetes.

“That is a bit of a shared savings model,” Cunningham said. “I believe one online program is called Cecelia, one is called DayTwo, both for weight loss. We’ve got a face to face diabetes program that is managed at local pharmacies. And then we have a host of other programs.” 

Cunningham answered a question about the PEIA CapitalRX vendor and their “diabetes guarantee,” intended to protect against the spiraling cost of diabetes drugs.

“Think of the Ozempics of the world,” he said. “Which is certainly a cost driver for PEIA right now. If the target cost of those drugs is exceeded, the guarantee kicks in and PEIA is paid back for some of the cost of those drugs.”

Cunningham said whenever he’s out in public, he’s bombarded with questions on when PEIA will cover the new anti-obesity drugs, including Wegovy.

“The reason we have such tight controls and a limited prescribing network for those weight loss drugs, is, in part, because of the cost to plan,” Cunningham said. “If we just opened up, Wegovy for example, and let anybody prescribe it, instead of a 10 and a half percent premium increase, I’d be standing before you here saying it’s a 15 percent premium increase or more.” 

Cunningham said later those numbers were an estimate. He told lawmakers he understands that people who have been on Ozempic, for example, may benefit from continuing to remain on Ozempic. He said those are things that PEIA is “looking at and studying right now internally.”