Magazine article Drug Topics

Charting a New Course

Magazine article Drug Topics

Charting a New Course

Article excerpt

With passage of HMO law, California weighs Rx benefit regs

California recently passed legislation designed to boost patient access to pharmaceutical benefits. Beginning in 1999, health maintenance organizations operating in California must make their drug formularies public for the first time. HMOs will also be required to continue to provide drugs that patients are currently taking, even if those products are later dropped from the formulary.

To put this legislation into effect, California recently held two days of hearings in San Francisco and Los Angeles. At the hearings, the state heard conflicting demands from managed care, manufacturer, pharmacy, and consumer groups.

Dale Bonner, commissioner of the Department of Corporations, which is responsible for regulating HMOs statewide, said, "As regulators, we have been monitoring the rapid emergence of new wonder drugs now on the market. We need to understand more completely the degree to which these new drugs are available to the more than 20 million Californians enrolled in HMOs.

We need to consider the impact these new drugs may have on the quality and accessibility of health care provided by health plans."

If Bonner was hoping for simple answers, he didn't get them. At the hearing, representatives from Pfizer and other manufacturers lashed out against attempts by HMOs to restrict patient access to new products, calling them illegal, immoral, and ineffective. State regulators, on the other hand, called for even tighter controls on drug benefits to control costs, while consumer groups called for more drug coverage in order to reduce medical and hospital costs.

Patient advocacy groups complained that the new rules don't go far enough. HMOs will still be allowed to exclude specific drug products or treatments from pharmacy and other covered benefits.

Mark Ebert, a member of the board of directors for RESOLVE of Northern California, an infertility advocacy group, blasted HMOs for declining to cover infertility treatments in most cases. The reasons cited most often, he said at the hearing, are cost and the lack of medical necessity, but a recent U.S. Supreme Court decision classified reproduction as a major activity subject to the Americans With Disabilities Act. …

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