MASSACHUSETTS: HMOs May Drop State-Mandated Drug Coverage
Massachusetts is the only state that requires Medicare HMOs to provide unlimited prescription drug coverage, but that benefit "could soon disappear," the Boston Globe reports. While state law requires the benefit, the Medicare HMOs contend that last year's federal Balanced Budget Act frees them from the obligation. The Globe reports that advocates for the elderly are "alarmed" and state officials are "incensed" over the claim. Acting Gov. Paul Cellucci (R) said, "I simply will not stand by and let these benefits be cut." Geoff Wilkinson, executive director of Massachusetts Senior Action Council, said, "It's outrageous. This is the kind of greed and self-interest that leads consumers to demand HMO reform" (Pham, 8/19). In a letter to Health and Human Services Secretary Donna Shalala, Cellucci said the change would bring "harm to vulnerable consumers." He noted that 75% of the "nearly 200,000 Massachusetts seniors in Medicare HMOs take advantage of the benefit" (Convey, Boston Herald, 8/19).
Who's The Boss?
State health officials have been trying to clear up the conflict between state and federal law with the Health Care Financing Administration, which "hasn't responded." Barbara Anthony, chief of the state attorney general's public protection bureau, said, "It's our position that state law applies in this matter." In the meantime, "some HMOs are proceeding with plans to scale back drug benefits, beginning in January." Among the HMOs awaiting approval for new plans are:
- Blue Cross and Blue Shield of Massachusetts -- Wants to "cap prescription drug coverage at $1,200 a year and charge $60 in monthly premiums for its BlueCare 65 HMO." Its Medigap plan, Medex Gold, would still offer unlimited drug coverage.
- Harvard Pilgrim Health Care -- Would like to "offer a maximum of $800 in prescription drug benefits per calendar year." Members of its First Seniority HMO in the eastern part of the state would receive this benefit at no charge, while their counterparts in the west would pay a $25 monthly premium.
- Tufts Health Plan -- Disclosed that "it had filed a request with HCFA to sell a plan with limited drug benefits, but declined to reveal its figures." Its Secure Horizons plan is the largest Medicare HMO in the state.
- Fallon Community Health Plan -- Plans to "continue offering an unlimited drug plan," but "that could change," said Jay Fagan, co-executive director of the plan.
All For One And One For All
The HMOs said they are faced with a dilemma because if one plan keeps the unlimited benefits while the rest institute limited plans, "the sickest seniors needing the most medications" -- therefore the most expensive enrollees -- "would flock to the plan with unlimited benefits." Harvard Pilgrim spokesperson Patti Embry-Tautenhan said, "Harvard Pilgrim believes that the best public policy would be for every Medicare HMO in Massachusetts to offer full drug coverage. However, unless all Medicare HMOs offer full drug coverage, it would be financially irresponsible for us to do so." But if all HMOs "theoretically" agreed to offer unlimited coverage, that could "violate state antitrust laws," noted Harvard spokesperson Alan Raymond (Globe, 8/19).