Today's single payer post: Who wrote your last Rx?
A report just released this weekend by state Senator Jeffrey Klein (Democrat) reveals that some New York state HMOs restrict patient access to single source drugs or brand name medications for specific ailments that do not have lower cost generic versions. The report includes a survey of the 15 HMOs with drug plans in New York state, including Aetna, Oxford Health Plans, Cigna, Health Insurance Plan of New York, Group Health Associates, and HealthNet of New York and was conducted to determine how and if companies restrict prescriptions to 20 of the most common single-source drugs. The results point to HMOs setting these restrictions to increase their bottom lines and enhance profits.
The survey confirmed that a number of restrictions are placed on consumers, such as a “medical exception,” imposing quantity limits, and a “step therapy” rule. A medical exception is when a patient and physician must obtain prior permission from the insurer so that a patient can receive coverage for a prescribed medication. Medical exceptions are granted at the discretion of the insurance company. Step therapy forces patients to try one or more other medications before seeking approval for a prescribed drug. “It’s a dangerous situation,” Klein said. “Clearly, when a doctor prescribes a specific medication for a patient and they know that drugs works for a patient, they shouldn’t be forced to use a generic drug or cheaper alternative that may not work,” he added.