MCOs deny members drug info
Millions of Californians are denied access to information about the medications covered by their own managed care health plans, according to a survey by the consumer advocacy group, Citizens for the Right to Know.
"We conducted this survey to find out if consumers are able to get the information they need before they enroll in a health care plan. And the answer is, that a majority of the time, their requests are not being met," says Joan Stevie, president of the Arthritis Foundation, Northeastern California Chapter one of 70 organizations supporting Right to Know.
The coalition contacted 48 HMOs, who provide services to almost all of California’s 14 million managed care enrollees, and requested copies of their drug formulary list, then recorded the responses.
The group will use the survey results to back up the need for a bill sponsored by Democratic California State Senator Rosenthal. The bill, SB 625, would require health care service plans to disclose their formulary lists to consumers and to inform enrollees about the procedures for obtaining a nonformulary medication.
The findings of the Right to Know survey included:
• 10% of the HMO customer service representatives don’t know what a drug formulary list is.
• 35% of the HMOs had no one available to answer a simple yes-or-no availability question. In one case, an HMO member services representative said the purpose of their formulary is to keep costs down. She said that if doctors want to prescribe something else, they would have to prove that the drug is medically necessary and financially appropriate by initiating an extensive review processes that could last weeks or even months.
• 23% of the HMOs stated their drug lists are proprietary and only available to doctors and pharmacists not to their members or to prospective enrollees.
• Fewer than 8% said their plans cover anything a physician prescribes and there is no need for a formulary list.
• 4% of the smaller HMOs contract out their drug plans and said they did not have access to their own coverage information.
• 4% use Medi-Cal’s formulary.
• 21% of the plans were responsive and either faxed or mailed the formularies upon request.
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