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HMOS FACE DRUG-COST PROTEST

Patients angry over increases in the cost of injectable drugs that they administer themselves plan to picket the region's three largest health-maintenance organizations.

They also said a lawsuit is being prepared against the insurers, accusing them of discrimination.

Meanwhile, one of the companies, Health Care Plan, is moving ahead with a proposal for state legislation that would require all insurers to treat self-injected drugs like any other drugs.

"We've been the only ones covering these drugs in full. We can't afford to do that unless we're on a level playing field with other insurers," said Dr. Arthur Goshin, president and chief executive officer of Health Care Plan.

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 increases argue that there is no medical rationale for them, that the decisions single them out simply because they require a self-administered injectable drug. They also say the change would leave them with no alternative health plan with affordable prescription coverage.

"The HMOs have backed families into a risky medical or financial corner," said Earl Cantwell, whose daughter uses synthetic growth hormone.

He and others plan to picket HMO headquarters Oct. 21.

Health Care Plan's new co-pays will vary from minimal payments that patients now make. Most members will pay 20 percent or 50 percent of a drug's cost. Some others may pay nothing, depending on an employer's level of coverage.

Health Care Plan, which insures about 150 patients who self-inject, plans to retain full coverage for existing members in 1998 in hopes that its legislative efforts succeed.

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

The other major managed-care plan in the region, Community Blue, the HMO of Blue Cross and Blue Shield of Western New York, instituted a 50 percent co-payment for the drugs a few years ago.

HMO officials have defended the co-payment increases, saying they reflect large increases in the overall cost of pharmaceuticals.

Health Care Plan 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 Health Care Plan.

Goshin acknowledged that the practice of lumping all self-injecting patients together was unfair because patients who administer medications in other ways also use expensive drugs.

Nevertheless, Goshin said, Health Care Plan could no longer afford to be the only insurer with low co-payments for self-injected medications.

The co-payment increases will take effect Jan. 1, pending approval by the New York State Insurance Department.

Goshin said Health Care Plan asked the Insurance Department to require all HMOs to provide uniform prescription coverage, but the regulatory agency countered that such decisions were not within its jurisdiction.

Assemblyman Paul A. Tokasz, D-Cheektowaga, recently said he would introduce legislation to prohibit insurers from charging a co-payment of more than 20 percent for multiple sclerosis drugs that patients inject themselves.

But Goshin and others say that proposal does not go far enough, that it should require all insurers to treat all self-injectables like other drugs.

It is difficult to say if such a measure would pass. The self-injectable issue is a local one for now and not a statewide concern.

But officials said the proposed measure does not mandate a new insurance benefit, which may avoid insurance industry opposition.

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