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HMO SEEKING UNIFORM PRESCRIPTION COVERAGE FOR DRUGS THAT PATIENTS SELF-INJECT AT HOME

HealthCarePlan will ask the New York State Insurance Department to require all health maintenance organizations to provide uniform prescription coverage for drugs that patients inject themselves at home.

The proposal follows criticism from HMO members of the recent decision by HealthCarePlan and Independent Health to significantly increase the co-payment for such drugs as of Jan. 1.

HealthCarePlan officials also said this week that they would apply the higher co-payments to new members only.

Patients have reacted angrily to the new policies because many of the drugs at issue are expensive, costing as much as $2,000 a month. They include new medications for multiple sclerosis, chemotherapies for cancer patients and synthetic growth hormone for small children.

Critics of the price increase contend that there is no medical rationale for it, that the decision singles them out simply because they require a self-administered injectable drug.

They also say the proposed change leaves them with no alternative health plan with affordable prescription coverage.

HealthCarePlan's new co-payments will vary from the minimal payments patients currently make. Most members will pay 20 percent or 50 percent of a drug's cost, while some others may pay nothing, depending on an employer's level of coverage.

Independent Health's out-of-pocket expense for members will rise from 20 percent to 50 percent of a self-administered drug's cost.

There is one other major managed-care plan in the region, Community Blue, the HMO of Blue Cross and Blue Shield of Western New York. Several years ago, it also instituted a 50 percent co-payment for self-administered injectable drugs.

HMO officials have said the co-payment increase reflects large increases in the overall cost of pharmaceuticals.

HealthCarePlan officials also say they took on an unacceptable amount of financial risk when Community Blue and then Independent Health raised co-payments, forcing many patients who self-inject the expensive medications into HealthCarePlan. Officials at the HMO said they wanted to help the patients but could not afford to be the only insurer with low co-payments for self-injected medications.

"Our request to the Insurance Department is an attempt to look at finding a workable solution," said Peter Kates, a company spokesman.

The proposed increase in the co-payment at Independent Health and HealthCarePlan, which have announced plans to merge with each other and a third HMO in Syracuse, require approval by the state Insurance Department.

Representatives of the agency said they had not yet received HealthCarePlan's proposal. They also said the requests for larger co-payments remained under review.

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