MANAGED CARE March 1999. ©1999 Stezzi Communications
The California Department of Corporations ordered six HMOs to restore coverage of prescription drugs that they trimmed from their formularies in the past several months. The state also prohibited the HMOs from making additional changes until it completes an investigation of whether formulary revisions were due to medical or financial reasons.
At the heart of the issue is a new law that takes effect July 1, granting continued coverage to any HMO member who is taking a particular medication, even after an HMO removes it from its formulary. A consumer group charges that the HMOs have been dropping coverage of certain drugs and patients are being switched to other treatments before the new law can kick in.
The HMOs say the changes were routine and did not violate the spirit of the law. Kaiser Foundation Health Plan, which deleted six drugs and added 25 to its formulary, says many of the changes involved drugs made obsolete by the development of newer or more effective pharmaceuticals. Still, the state is asking Kaiser and five other plans to provide minutes of formulary meetings.
In addition to Kaiser, the plans affected are Health Net, United HealthCare of California, Aetna U.S. Healthcare, Key Health Plan, and Molina Medical Centers.