Newspaper article The Florida Times Union

HMOs Put Some Drugs out of Favor Consumers Unhappy with Recent Moves

Newspaper article The Florida Times Union

HMOs Put Some Drugs out of Favor Consumers Unhappy with Recent Moves

Article excerpt

NEW YORK -- When Aetna Inc. posted a better-than-expected first-quarter profit last month, the nation's leading health insurer trumpeted its success at curbing skyrocketing prescription drug costs.

Here's Aetna's secret: In January, it stopped routinely covering some of the most popular medicines for many members.

Need Prozac for your depression? Sorry. Want the No. 1 U.S. cholesterol-lowering drug Lipitor? Too bad. Want the world's best-selling prescription drug, Prilosec, to treat your ulcer? Uh-uh.

These are among the 106 prescription drugs that Aetna U.S. Healthcare requires most of its members to buy themselves, or pay for at a higher co-payment than the drugs Aetna favors.

Nationwide, most large health plans have also restricted coverage of some of the top-selling drugs in an effort to control costs. For example, PacifiCare doesn't cover either of the top two selling cholesterol-lowering medications, Zocor or Lipitor. Oxford Health Plans, a major HMO in the Northeast, charges some members a premium for the leading allergy drug Claritin for adults.

HMO drug costs are expected to soar 20 percent this year, primarily because people are using more medicines and the situation is expected only to worsen. Overall health care costs are expected to rise only 5 percent.

HMO executives say they have little choice but to reduce access to many high-priced new drugs to keep annual premium increases in single digits.

But that reasoning is of little comfort to many consumers who are used to getting the drug their doctor prescribes, or the medication they have trusted for years to keep them healthy. …

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