MANAGED CARE REFORM: Wilson Signs Two Prescription Access Bills
Gov. Pete Wilson signed two bills into law yesterday that will give managed care patients greater access to prescription drugs, the Sacramento Bee reports. Both bills "require HMOs to tell patients which drugs are included on the plan's approved list and how that decision was determined" (6/23). "These bills will give consumers access to information on how drug coverage is determined and their rights to continuing medication that works for them," Wilson said. Assemblyman Martin Gallegos' (D-Irwindale) bill, AB 974, requires managed care plans to continuously provide prescription drugs for patients with long-term illnesses, even if the drug is removed from a plan's approved list. "It is important that we protect patients from having to switch to another drug due to changes in the plan's formulary, which may cause serious complications to the patient if the drug has different side effects," Wilson said. SB 625, sponsored by state Sen. Herschel Rosenthal (D-Van Nuys), requires HMOs to maintain an "expedited process" for approving patients' access to prescription drugs (Gov. Wilson release, 6/22).
Consumer groups generally welcomed the new laws, but said they were small advances that had already been embraced by the managed care industry, the San Francisco Chronicle reports. Jamie Court of Consumers Union said, "Any bills backed by the HMOs couldn't possibly answer all the problems for patients in life and death struggles with these companies." But health care industry officials warned that the two bills could increase HMO premiums. Maureen O'Haren, president of the California Association of Health Plans, said: "Prescription drugs are one of the fastest rising components of the health care budget." But she noted that her association backed the bills because "it is a good, responsible thing that we ought to be doing."
The Viagra Challenge
The San Francisco Chronicle reports that the two new laws "may pave the way for quick challenges of restrictions to coverage of controversial drugs." While it is unclear what impact the legislation will have until tested, the Chronicle notes that the laws "make it more difficult for health plans to deny patients prescription drugs." Men suffering from sexual dysfunction may create the first test of the laws in their appeal of some health plans' decisions not to cover the new impotence drug Viagra. Kaiser Permanente which announced last week it would not cover Viagra. Spokesperson Beverly Hayon said, "What these bills are promoting we already do. It is very difficult to ascertain medical necessity for Viagra. We'll have to see how this plays out" (Russell, 6/23).
Today's Contra Costa Times reports it "may not be too late to get a Viagra prescription from Kaiser," regardless of the two prescription coverage laws. The paper reports that a "little-noticed loophole" in Kaiser's policy gives some patients a "window of opportunity" to obtain the little blue pill. Kaiser's policy on Viagra takes effect when employers renew their contracts with the HMO, and as the Times notes, for most California businesses that does not happen until January. "In California, if you need Viagra today, a doctor would write a prescription and we'll cover it," Hayon said yesterday (Appleby, 6/23).