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Disability in the News.

Consumer Group Questions How HMOs Will Implement Disclosure to Consumers.

SACRAMENTO, Calif.--(BW HealthWire)--July 14, 1998--In the aftermath of Gov. Pete Wilson's signing of significant health-care disclosure legislation late June, consumer-advocate group Citizens for the "Right to Know" is questioning how California HMOs plan to implement disclosure.

"We applaud Gov. Wilson's action in signing disclosure bills SB 625 and AB 974, but when the laws go into effect Jan. 1, we want to know how HMOs plan to comply," said Liz Helms, member of Citizens for the "Right to Know" and president of the TMJ Society of California.

"Right now we are in the process of writing letters to all the HMOs in California, asking what action each will take in order to comply with the new laws. It's our plan to cooperate with HMOs to determine how we might work together to ensure that health consumers get all the prescription coverage information they need to make informed decisions."

Among other requirements, the newly signed legislation mandates that HMOs disclose their formularies, or lists of covered drugs, and the process by which they make coverage decisions.

"As the April '98 `Right to Know' survey showed, millions of Californians enrolled in managed-health plans have no idea which medications are covered by their health insurers, much less how a plan member can go about requesting a nonformulary or uninsured medication," Helms said. "The current controversy about Viagra coverage exemplifies the confusion about how health plans determine what medications are covered. We want to know how HMOs plan to address this problem."

While some provisions of the new laws mandate that the procedure for approving or denying coverage of a nonformulary drug be expedited, the coalition is concerned about the fact that many new and innovative medications are often excluded from formularies, effectively denying patients new treatment options, Helms said.

Citizens for the "Right to Know" is an alliance of more than 80 health- care organizations and consumer groups whose focus is to educate consumers about the need to become informed purchasers of health care.

Members include: Arthritis Foundation, Northeastern California Chapter; American Association of Retired Persons; American Lung Association, Long Beach Chapter; California Medical Association; Cystic Fibrosis Foundation; Hemophilia Council of California; International Patient Advocacy Association; Latino Issues Forum; Mental Health Association in California; National Multiple Sclerosis Society, California Chapters; Pharmaceutical Research and Manufacturers of America; Sickle Cell Disease Association of America Inc. and TMJ Society of California.

CONTACT: The Perry Group Kassy Perry, 916/443-7239 or California Psychiatric Association Conni Barker, 916/442-5196  
 

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