DRUG FORMULARIES: DOC Orders Five HMOs to Restore Drugs
The state Department of Corporations has ordered Health Net "to cancel plans to delete 14 drugs from the list of medications available to its members." Similar orders also went out to four other HMOs, mandating that they restore as many as seven drugs each to their respective formularies. The DOC's order to Health Net, the second this year, requires the HMO to restore Prozac, Zyprexa and two cystic fibrosis drugs, among others. Officials from the HMOs "said they will comply with the directive," but "insist they have done no wrong." DOC Supervising Counsel Warren Barnes said the orders stem from "very serious allegations that medically necessary drugs were being taken off the formularies." But he noted that the department has permitted many more drugs to be deleted than not, allowing Health Net, for example, to delete 58 drugs. Elizabeth Helms of Citizens for the Right to Know said the DOC "has done an outstanding job in investigating this, and it's a real victory for consumers. The drug switching and the denial (of drugs) problem is real, even though the plans want to say it's not."
The Other Guys
The other HMOs affected by the DOC's order are:
- Kaiser Permanente: Kaiser was ordered to keep one drug on its formulary, Respigam, an IV preparation for infants that the HMO said it was deleting in favor of a better alternative. Sharon Levine, associate executive director of the Permanente Medical Group, said, "We don't believe there's any clinical basis for requiring the restoring of ... a drug that's not as good as the replacement."
- Aetna U.S. Healthcare of California: Aetna was ordered to restore seven drugs, including Prozac and Prilosec. Spokesperson Bobby Pena said "the order affects only about 4,500 of the plan's 500,000 enrollees."
- Molina Medical Centers: Long Beach-based Molina was ordered to keep Zoloft and Prilosec on its list, even though CEO Mark Mario Molina said those drugs had been eliminated "for lack of utilization or because we found something more efficacious"; he noted that only 12 members currently take either drug.
- Key Health Plan Inc.: Key must restore Prilosec to its formulary (Benson, Wall Street Journal/California Edition, 4/14).