CONNECTICUT: Largest HMO Moves To Limit Drug Coverage
Connecticut's largest HMO, Physicians Health Services, will join "a growing number of health plans nationwide" that are restricting the amounts of certain drugs physicians can prescribe. The Hartford Courant reports that in an effort to address "what they see as waste and inappropriate drug use ... some insurers are saying how many pills, vials, or inhalers" are included in the 30-day supply covered by the HMO. As a result, physicians "must apply to the health plan" to justify a the prescription of more pills or a higher dosage than specified by the insurer. The new "drug edit" restrictions exceed current company practices that limit "insurance coverage to a 30-day-at- a-time supply, chec[k] for drug interactions or requir[e] doctors to stick to" an approved drug formulary. And the move leaves doctors frustrated that the limitations will erode doctor-patient relationships, create "anxiety for patients [and] increase paperwork."
The Courant reports that some 20,000 Physicians Health enrollees "in the tri-state region, including about 9,000 in Connecticut," exceed the new drug benefit limits outlined in the "drug edit" program, set to begin Nov. 15. The HMO said all affected patients will be notified and that once the program has been implemented, few physician requests will be denied and responses to those requests will be made within 24 hours. "We're never going to let patients be without their medication," said Barry Katz, vice president of integrated pharmaceutical services for Foundation Health Systems' Eastern Region. However, such assurances are "little consolation to some doctors" concerned about the program's impact on their practices. And the trend is expected to continue, as "Anthem Blue Cross and Blue Shield of Connecticut plans to introduce a similar program soon" (Levick, 10/26).