CMA Comments on Proposed HMO Drug Coverage Rules
[Posted 10/06/05]

CMA recently submitted comments on the Department of Managed Health Care’s revised HMO drug coverage regulations, urging the department to strengthen patient protections to ensure medications are accessible and affordable. The proposed regulations would implement a 2002 law (SB 842) that gave DMHC full authority to review and approve health plan outpatient prescription drug coverage exclusions and limitations, including copayments that impact patients’ access to prescription drugs.

CMA expressed concern that the regulations continue to allow health plans to deny patients practical access to medically necessary prescription drugs. CMA believes that treating physicians should always determine medical necessity and that HMOs should not be able to deny patients medically necessary drugs, either by excluding the drugs from health plan formularies or by requiring patients to pay excessive out-of-pocket costs.

Click here to download a copy of CMA's comments.

Contact: Astrid Meghrigian, 916/444-5532 or ameghrigian@cmanet.org