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New York Daily News: Prescription Prescription drug coverage marred by bureaucracy, survey says
By Bill Egbert
Everybody seems to agree that nobody wants bureaucrats standing between patients and their doctors.
That's just what's happening already with many prescription drugs, according to a study released Sunday.
The survey of New York's 11 largest health maintenance organizations by state Sen. Jeff Klein (D-Bronx & Westchester) showed that all of them restricted coverage of several "single-source drugs," or new drugs still under patent with no cheap generic equivalent.
A group of patients, doctors and elected officials joined Klein in front of the Manhattan headquarters of Empire Blue Cross and Blue Shield to denounce the HMOs' latest penny-pinching measure.
"What this and other HMOs do every day is put profits over patients' health," Klein said.
The issue is not the widely accepted cost-cutting policy of replacing pricy name-brand drugs with chemically identical generics.
There are no cheaper equivalents to single-source drugs, so HMOs are requiring doctors to prescribe entirely different medications.
These alternative drugs ostensibly treat the same ailments, but through completely different chemical mechanisms with vastly different side-effects. HMO bean counters dictate these treatments even when doctors think this will jeopardize their patients' care, according to the study.
"We want to be treated by the doctors we choose, not some 25-year-old in a call center," said JoAnn Quinn of the Lupus Alliance.
She's had lupus for 40 years but says in the past four she's had increasing trouble getting her 16 medications.
The problem is made worse by how frequently insurance companies change drug benefit managers, subcontracted firms that have different restrictions for different drugs.
Millie Mercora, 73, of the Bronx cares for her developmentally disabled sister, Martha Carotenuto, 67, who has a chronic digestive condition treated effectively for several years with a single source drug.
Her new Medicare drug benefit manager now refuses to cover that medication, and insists that Carotenuto try other medications that her doctor thinks either won't help or may even aggravate other conditions with their side effects.
"It's crazy," said Mercora. "The other insurance company covered it. Why don't they listen to her doctor?"
Klein has introduced a bill in the State Senate, with Assemblyman Adriano Espaillat (D-Washington Heights) pushing its counterpart in the Assembly, that would require insurers to cover single source prescriptions for patients whose doctors insist on them.
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