CINCINNATI — Retired city of Cincinnati workers are asking the city to pay nearly $123,000 in attorney bills they’ve accrued fighting changes to health care benefits, such as the removal of Viagra and Cialis from prescription coverage.
The retired workers filed a motion in U.S. District Court on Tuesday, asking the city to pay legal bills from January 2017 to November 2019. The retirees’ attorneys, who charge between $425 and $775 per hour, anticipate future legal bills from a widening dispute over what benefits the retirees say they are entitled to, and what the city says it can afford.
After months of brokering, the city and its retired workers reached a historic agreement in 2015 that solved a looming pension crisis. It allowed the city to move $200 million from its health care fund to the pension fund. In exchange, the city agreed not to significantly change health care benefits.
“As the court knows well, the years since the agreement was executed have seen a steady flow of disputes, motion practice, meetings, and negotiations as the parties have worked to address new and old issues under the agreement and avoid all-out litigation,” the retired workers' attorney, Peter O’Shea, wrote in the motion for legal fees.
The city will continue to cover erectile dysfunction drugs necessary as part of a medical condition, such as an enlarged prostate, but ended coverage of lifestyle or recreational use of the drugs in July.
“Not every drug which seeks to address the admittedly unpleasant effects of the aging process is, in the strictest sense, ‘medically necessary' and subject to full insurance coverage,” the city’s attorney, Steven Goodin, wrote in a July motion.
The Cincinnati Retirement System is expected to spend an estimated $34 million on retiree health benefits in 2019 and coverage for prescription drugs accounts for half of that, City Manager Patrick Duhaney wrote in a June 4 memo to city council.
“This trend is expected to increase at alarming rates due to escalating costs for brand-name drugs, new and specialty drugs coming to market at ever-higher prices, and increased utilization,” Duhaney wrote.
The city recently added numerous new drugs to its health plan, including ones which cure Hepatitis C and dramatically improve the life expectancy for certain cancer diagnoses, and it did so without court approval, Goodin wrote.
He argued the city is entitled to make routine tweaks to its health care plan without U.S. District Court Judge Michael Barrett’s oversight.
“The (agreement) proscribes only wholesale ‘reduction of benefits’ and not routine, cost-saving tinkering with drug formularies,” Goodin wrote. “If the court were to become involved at this granular level of plan management, the parties will be before it on a quarterly basis until the consent decree expires in 2036.”
“Moreover, as of the date of this filing, counsel for the retirees class continues to investigate the city’s September 2019 announcement that it will transition … from a self-insured plan to a Medicare Advantage Plan effective January 1, 2020,” O’Shea wrote. “This seismic change was determined unilaterally by the city … The city’s go-it-alone process —that refuses to involve or even consult the retirees class — violates the spirit and letter of the agreement.”
That transition will continue to require “substantial involvement from counsel” to ensure that the new plan substantially complies with the agreement, O’Shea wrote.
