Dear Fellow Members,
I wanted to take this opportunity to clarify the reasons behind our transition from our previous Medical Consultant, USI, to our new Medical Consultant, Foster & Foster, as well as move from our previous Pharmacy Benefits Manager, Welldyne, to our new Pharmacy Benefits Manager, CapitalRx.
A Medical Consultant, much like an Investment Consultant, provides advice on medical and pharmaceutical products and services. The Pharmacy Benefits Manager specifically oversees the day-to-day fulfillment of prescriptions, including the delivery of mail-order medications to our members.
Over the past 20 years that I have served as a Trustee with The Fund, we have transitioned between several Pharmacy Benefits Managers, guided by the expertise of our Medical Consultant, at that time USI. These transitions were driven by various factors, such as failure to meet agreed-upon performance metrics (including customer service and rising service costs) as well as the acquisition and merger of some of our previous providers. We had moved from PTRX to Catamaran, then to Envision, and finally to Welldyne. Each of these transitions involved disruption, much like the current shift from Welldyne to CapitalRx.
It is considered a best business practice to periodically assess the performance of your consultants through a process known as a request for proposal (RFP). Over four years ago, we began implementing a Strategic Plan to thoroughly evaluate our current providers. Our goal was to ensure both compliance with our Fund’s Plan Document and the provision of high-quality customer service at reasonable and sustainable medical costs. Cost containment is crucial to ensure we continue to have the funding to provide quality medical benefits, not only for our current members but for future members as well.
Our current Plan Document was created by the 2007 move of the Healthcare Fund into Texas State Law with status, like the Pension Fund. Also like the Pension Fund, we can only change benefits in the Plan Document if there is a cost-neutral or positive-cost impact to The Fund. The Board cannot arbitrarily change the Plan Document except under those circumstances; otherwise, the change requires a language change in the law. The Plan Document sets out the medical and pharmaceutical coverages that we are authorized to provide to our members.
The first step in the Strategic Plan process was to submit an RFP for a Medical Consultant. USI, our consultant at the time, and Foster & Foster submitted proposals, as did other candidates. After a comprehensive evaluation of the submitted proposals, the Fund’s Board of Trustees selected Foster & Foster to support the implementation of our Strategic Plan.
Foster & Foster subsequently initiated the RFP process for a Pharmacy Benefits Manager. Welldyne was invited to submit a proposal to continue as our provider, just as we had invited USI during the Medical Consultant search.
However, Welldyne chose not to submit a proposal, thus removing themselves from consideration. H-E-B withdrew their proposal since they could not provide a mail-order service. The Fund’s Board then proceeded to interview the remaining candidates (Kroger and CapitalRx), ultimately selecting CapitalRx.
Both Kroger and CapitalRx contract with a mail-order pharmacy, with CapitalRx utilizing Optum for this service.
Since the transition to CapitalRx, it has become apparent that Welldyne was not fully adhering to our Fund’s Plan Document as required. Welldyne was allowing and processing prescriptions for drugs that are either excluded from coverage or require specific approval steps under our Plan Document. This issue has led to unexpected disruptions for our members, whose medications were filled and billed to The Fund in error. The Fund’s Board and Fund Benefits Specialists are actively working to address these issues. Any member encountering such problems is encouraged to contact a Fund Benefits Specialist for assistance. We need to be aware of these issues so that we can resolve them and prevent future occurrences.
As your Police Retiree Representative, as well as on behalf of the Fund’s Board of Trustees, I want to express how deeply upsetting this situation is. We envisioned a smooth transition, with the only anticipated disruption being the new paperwork required of each member to begin the year with the new vendor.
Additionally, we are engaged in legal discussions with Welldyne over other issues. I will address those issues once they are resolved.
Further complicating the ongoing searches during the implementation of the Fund’s Strategic Plan, approximately two years ago our Pension Board approached our Board with a request to take over the collection of contributions to our Fund. In our State law, the Pension Fund is required to collect the sworn members’ and the City’s contributions to our Fund; transfer then transfer the collected contributions to our Fund. Because the implementation of a new software process would be an increased cost to The Fund, we initiated a state legislative package to absorb the cost and allow us to collect the contributions. All affected parties (Fire/Police/Pensioners Associations and the City of San Antonio) were then asked for input and then asked to support the legislative package.
After meeting with all affected parties, we added several of their requests to the package. Widows of members would now be allowed to remarry without losing The Fund’s medical coverage. It also addresses sworn married couples’ contributions to The Fund. Additionally at the time of retirement, an early lump-sum payment of the remaining required contributions would be offered. After resolving some questions from the Fire Association concerning the contributions by their membership, the Board’s legislative package has received the endorsement from all affected parties and is now moving forward.
Also, on a positive note, we have a Physical Therapist and added a Physical Therapy Assistant at each location. We have a new dedicated Musculoskeletal Specialist (Sports Medicine) doctor as well as a full-time licensed professional counselor.
As your representative on the Fund’s Board, I am open to meeting with you on any issues or to answer questions. My Fire Counterpart, Frank Gutierrez, is also available. Our Board is made up of a Mayoral Appointee, two City Council members, two active firefighters, two active police officers, and only one police and one fire retiree representative. That said, I have a vested interest in this Fund, this is my medical coverage, my family’s my friends’ medical coverage, and we all need these now more than ever. If you know me at all, you know I won’t stop fighting for any of us.
If you have any questions or concerns regarding your medical and prescription benefits, please contact The Fund Retiree Health & Wellness San Antonio Fire and Police at 1-866-652-4237.
Mike Despres, Police Department Retiree Representative, mdespres@thefundsa.org
Frank Gutierrez, Fire Department Retiree Representative, fgutierrez@thefundsa.org
