FORMULARIES: Under Scrutiny
Formularies, or lists of medications "whose costs a health insurance plan promises to cover," are under "increasing scrutiny nationwide and in California, where they are the subject of at least three pieces of pending legislation," the Fresno Bee reports. Insurers and HMOs say "formularies help zero in on the most effective drugs, keeping costs low by allowing the favored medications to be bought in sizable quantities." HMOs in the state say drug selection "is based on a drug's safety, usefulness and cost," and decisions are made by a committee of doctors and pharmacists. But pharmacists and doctors "insist that formularies create an expensive paperwork jungle of mixing and matching a patient's medical needs with what his plan will pay for," and doctors "worry whether they're being stripped of a major role in safeguarding patients." Betsy Imholz, a senior attorney with Consumers Union, "an advocacy group in San Francisco that tracks formularies and other aspects of managed care," said, "Pharmaceutical costs are rising and, as a result, there is a tremendous effort to cut back on medication by use of formularies."
The Fresno Bee reports that California lawmakers are "reviewing at least three bills that would give the public some protection on formularies." SB 1607 "would establish guidelines for adding drugs to the Medi-Cal formulary." AB 974 "would limit how formularies could be changed, so that a patient wouldn't be cut off from a medication without a physician's review," and SB 625 "would require health plans to provide copies of formularies to the public on request." SB 625, and possible AB 974, will go to Gov. Pete Wilson some time this month for his signature. Michael Shapiro, staff director of the state Senate Insurance Committee, said the governor is expected to sign both bills (Taylor, 6/3).