DRUG FORMULARIES: DOC Clears Kaiser of Wrongdoing
Kaiser Permanente has been cleared of all charges regarding its drug formulary after a six-month investigation by the Department of Corporations failed to uncover any evidence of wrongdoing. The Contra Costa Times reports that the DOC suspected Kaiser and five other HMOs of using "bait and switch" tactics to lure members, only to later drop several drugs, and well as evading a "continuity of care" law that "requires HMOs to continue to provide medications for patients, even if health plan officials later drop the drug from lists of approved medicines." Kaiser spokesperson Tom Debley "said the HMO was confident it would be vindicated," especially given its policy of allowing physicians to prescribe off- formulary drugs without prior permission and without requiring a higher co-pay (McMillan, 6/16). Debley added, "It reaffirms that this system ... is working well and is a benefit to members" (Griffith, Sacramento Bee, 6/16). Still under investigation are Aetna U.S. Healthcare, Health Net, Key Health Plan Inc., Molina Medical Centers and United Healthcare of California, though the plans have complained that the investigations were spurred by complaints from an organization -- Citizens for the Right to Know -- whose members include a pharmaceutical trade group. The California Association of Health Plans also protested that the DOC "relied on a handful of anecdotal complaints in making high- profile accusations of wrongdoing" (Contra Costa Times, 6/16). CAHP's Walter Zelman said, "We wouldn't question their right to monitor the process of formulary-setting. The concern was that they were going to substitute the judgement of regulators and a handful of consultants for the collective thinking of dozens of pharmacists and physicians at health plans" (Bee, 6/16). But Citizens for the Right to Know's Liz Helms "said the insinuation that her group raised the issue on behalf of the pharmaceutical industry was ridiculous," adding, "What prompted this were legitimate complaints from patients who had been drug-switched or denied medication. This is a real problem. It's still going on" (Contra Costa Times, 6/16).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.