University of Minnesota students in occupation via No Sweat

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• illegally subcontracting the cleaning and maintenance work at its downtown Ann Arbor facility to an outside firm without prior notice or bargaining with the union (UFCW Local 876);
• unlawfully insisting that the union agree to the elimination of the cleaning crew from the store as a condition in reaching a collective bargaining agreement;
• unlawfully suspending and discharging a union supporter;
• unlawfully interrogating employees about the union organizing drive;
• unlawfully threatening employees with discipline if they discuss discipline with other employees;
• unlawfully instituting more onerous working conditions.

for more: Borders Readers United

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New York Times October 5, 2003
By SANA SIWOLOP

IT’S open enrollment season again for many of the 175 million or so American workers and retirees in employer-sponsored health insurance plans. Over the next few weeks, the participants will have a chance to revise their coverage for next year.

As rising health care costs continue to make headlines, many employees are bracing for higher insurance premiums and co-payments for doctor’s visits or medical procedures. Benefits experts also suggest keeping a close watch on prescription drug coverage in their plans – and to be prepared to pay more out of pocket for these costs, too.

There are ways for employees to keep some of their prescription costs in check, if they are willing to do a little legwork and to be flexible. For instance, they can switch to generic brands, buy in bulk and search the Internet for the lowest prices. But, most important, they should carefully review and compare the drug coverage in all the health plan offerings.

Kenneth Sperling, a health care consultant at Hewitt Associates, a human resources consulting firm based in Lincolnshire, Ill., said that 2004 “is going to be a year of change, and it’s a good idea for employees not to assume that the drug benefits they had this year are what they will have next year.”

Since 2001, companies’ cost for providing prescription drug benefits to employees has increased 19 to 20 percent annually, according to the Segal Company, a benefits and human resources consulting firm in New York. Segal predicts an increase of 18 percent in 2004.

Benefits experts say that employers will bear much of the extra cost for prescription drugs, but that they will continue to shift some of it to workers next year, sometimes through higher co-payments. A growing number of companies will make their employees pay a percentage of their drug bills, usually around 20 to 30 percent, instead of fixed co-payments. This year alone, 47 percent of employers raised employee co-payments for prescription drugs, according to a recent study by the Kaiser Family Foundation and the Health Research and Educational Trust. The study, released last month, reviewed employer-sponsored health benefits offered by 2,800 companies.

Among other changes for 2004, according to benefits experts, is a continued move away from two-tier drug plans, which typically require a larger co-payment for brand-name drugs versus generic products, to three-tier plans, which add a middle co-payment amount for “preferred” brand-name medications. Co-payments for all three categories are expected to go up next year – by 9 percent, on average, for generic drugs and 20 percent, on average, for either tier of brand-name drugs, according to Hewitt Associates.

And experts say more companies are expected to demand that their employees use mail-order pharmacies, often affiliated with their health plans, for ordering maintenance drugs for chronic medical conditions like high blood pressure.

“These are trends that started last year, and we’re seeing considerably more of them this year,” said Thomas C. Billet, a senior consultant for the consulting firm Watson Wyatt Worldwide.

Some people are easily adapting to the changes. Eileen Kellner, a retired health care administrator for Columbia University, said she learned recently that the co-payments for the six prescription drugs she takes regularly for a heart condition would double, to $10 for generic drugs and to $30 for brand names.

But she is not too concerned. “I have an excellent plan; I’m one of the fortunate ones,” said Mrs. Kellner, who is in her early 70′s and lives in Hartsdale, N.Y. Millions of retirees, she noted, do not even have prescription coverage.

Susan Brown, a spokeswoman for Columbia University, said that the changes affected only drugs obtained through the plan’s mail-order pharmacy. But she said that health plan participants were still better off buying through mail order than in a retail store because they could buy in bulk and ultimately receive a discount.

FOR some people, especially those who require large quantities of prescription drugs, the increases have been painful.

Christine Harry, 58, who lives in the Cleveland suburb of South Euclid, says she takes 20 prescription drugs daily for a host of medical conditions that include severe asthma, psoriasis, facial shingles, fibromyalgia and depression. Mrs. Harry gets her prescription drug benefits through her husband, a factory machinist. Last year, she said, the benefits were changed and her co-payments doubled: it now costs $10 for a generic drug, $25 for a drug on the plan’s preferred list and $50 for a drug that is not on that list. Last year, she said, the co-payments totaled $4,000.

To help deal with the increases, Mrs. Harry said, she switched about a half-dozen medications to generic brands and began relying on her doctors for samples of any drugs not available as generics. Even so, she said, she is still spending about $200 out of pocket each month for prescriptions, a cost that she said played a big role in the recent decision by her and her husband to sell their home and move to an apartment.

Some consumers are fighting back. Lindsay Farrell, 46, chief executive of the Open Door Family Medical Centers in Ossining, N.Y., says she often asks questions about the cost of medications that are prescribed for her and for her two children. About half the time, Ms. Farrell said, she receives a prescription for a less expensive drug as a result. She said she still remembers the eye-drop prescription given to her about a year ago for a minor eye infection by a nurse practitioner who had recently received samples of the drops from a drug company representative.

“She thought that she would be prescribing the latest and greatest for me, but I insisted that she write me another prescription,” she said, because the first drug was not on her health plan’s list of preferred medications and would have cost her $90. Instead, she said, she paid only $10 for another brand that was on the list.

Comparison shopping can cut drug costs, too. Prices can vary greatly among chain stores, independent drugstores, mail-order companies and online pharmacies. Buying in bulk, perhaps through a mail-order pharmacy or turning to a generic version of a drug, may also help. David Moskowitz, a senior pharmaceutical analyst at Friedman, Billings, Ramsey, predicted, for example, that a growing number of generic products for high cholesterol and depression would hit the market over the next three years.

Some consumers can also take advantage of the coupons that a few health insurers, like WellPoint Health Networks, have been issuing lately for generic drugs or over-the-counter medications. Last December, WellPoint, which is based in Thousand Oaks, Calif., began offering $10 coupons toward the purchase of Alavert, the over-the-counter version of the generic ingredient in the allergy medicine Claritin, and in late September began issuing similar coupons for the purchase of an over-the-counter version of the heartburn medication Prilosec.

MANY drug manufacturers have been focusing on over-the-counter versions of certain drugs. As a result, some employers have been dropping insurance coverage altogether for certain classes of those drugs. That was the case with Claritin; when it became available over the counter, many employers refused to cover any prescription allergy medication. Now that consumers can buy an over-the-counter version of Prilosec, some benefits consultants expect employers to exclude coverage for this class of drugs as well, even though the stronger prescription version may still be appropriate for some people.

What can employees do? They can appeal to the employer’s pharmacy benefits programs to have coverage restored, said Mr. Billet, the Watson Wyatt consultant. Some people, he says, have been successful.

Flexible spending accounts for medical expenses may also be an answer. Last month, the Internal Revenue Service ruled that these accounts, in which untaxed income is set aside to cover an employee’s unreimbursed health costs, can be used to pay for certain over-the-counter drugs. In its ruling, the I.R.S. specifically cited antacids, allergy medicines, pain relievers and cold medicines – but not dietary supplements or vitamins – as examples.

The ruling gives employers the option of deciding whether to allow these accounts to be used for over-the-counter drug purchases for 2003 or for future years. Still, in a recent survey of large employers, the Washington Business Group on Health found that virtually every employer planned to allow for the coverage. Fifteen percent would make the coverage retroactive for at least part of this year, while 56 percent planned to make coverage available as of Jan 1.

Richard Sinni, a managing director at PricewaterhouseCoopers, recommends that consumers start keeping records on how much they spend annually on over-the-counter drugs, and to hold on to their receipts. “If you already have over-the-counter receipts, don’t trash them yet,” he said. “You just might be able to use them for the entire year.”

Indeed, for some consumers, diligence as well as education are important in dealing successfully with rising drug costs. “I see both sides of the issue,” said Ms. Farrell, who runs a nonprofit group that provides medical care to low-income residents of Westchester County. “We want more generous benefits, but as consumers, we have got to educate ourselves.”

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