(BW) (IPAA/DRUG-SWITCHING) Patient Advocates Launch Campaign to Identify Potential Victims of HMO Drug Switching Policies

(BW) (IPAA/DRUG-SWITCHING) Patient Advocates Launch Campaign to Identify Potential Victims of HMO Drug Switching Policies

BUSINESS WIRE; Wednesday, July 1, 1998

SALT LAKE CITY--(BW HealthWire)--July 1, 1998--In response to an increasing number of calls from patients reporting problems associated with managed care's restrictive drug formularies, the International Patient Advocacy Association (IPAA) is launching a first-of-its-kind outreach effort to identify individuals who have been drug-switched by their HMO.

IPAA is placing advertisements entitled "HMOh, no!" in Utah's major daily newspapers to locate and assist patients who are experiencing detrimental effects from a drug switch or denial. The advertisement directs individuals to call IPAA at its toll-free number 800/944-7823, ext. 1037. The ad will also run in four other western states including Arizona, California, Colorado and Washington.

"Too many people are having their prescriptions changed for what appear to be financial considerations, and that's just not good medicine," said Lenny Van Pelt, M.A., J.D., founder of the International Patient Advocacy Association. Van Pelt suffers from Gaucher disease and knows first-hand what it is like to be denied access to life-saving medications and appropriate medical attention.

"Decisions as important as the quality of your health should be left up to the doctor and the patient," he continued.

But IPAA says the potential cost savings are only temporary and that the restrictions do more harm than good. "Most of the drugs currently restricted from HMO formularies are widely prescribed market leaders for the treatment of common health conditions and diseases. Oftentimes, the patient is switched onto a second-class, less effective medication, which likely means they will return to the hospital or their physician -- ultimately increasing insurance costs," Van Pelt stated.

"We hope that this project gives patients a place to call to report such concerns and will allow us to identify which plans and which medications are most often involved in this latest cost-containment trend," said Van Pelt.

Recently, IPAA was made aware that a number of important medications, including arthritis, high blood pressure, depression, osteoporosis, Alzheimer's and diabetes drugs are being denied at a rapid rate.

Examples of some of the problems already identified include the following:

- Southern California-based Beaver Medical Group sent letters to their physicians requiring them to switch all patients on Prozac and Zoloft to Paxil at the next refill request. The internal memo states the switch is necessary because of the "immediate savings of $25,000 for just Secure Horizons per year." It further states that all antidepressants are similar and the change should not be a problem. "Clearly Beaver Medical Group is attempting to comply with SecureHorizons restrictive drug formulary," Van Pelt stated.

- Felyce Thomas, a Santa Barbara resident, was denied access to a menopause medication prescribed by her doctor and was provided a less-effective drug. The switch caused Thomas to experience severe migraine headaches. Thomas was forced to fight her HMO before she was provided with the medication originally prescribed. Thomas stated, "Let your health plans, doctors and pharmacies know you are not satisfied with the answer 'no'! Do not accept the first denial, raise a fuss and demand you receive what your doctor prescribed. Call your plan, file a grievance, ask your doctor or pharmacist for help. Do not give up."

- IPAA also notes that the senior population is most vulnerable to HMO drug switching practices, because they are the least likely to fight for the correct medications. Van Pelt said they have heard stories from family members whose loved ones suffer from Alzheimer's, and senior HMOs will not allow doctors to prescribe Aricept, a breakthrough neurological drug. "Drugs like Aricept don't come in generic form and there isn't an equal substitute. They are forced to either pay out of pocket or are turned away by the pharmacist. They can't afford to pay for the drugs and they have nowhere to turn for help," Van Pelt stated.

IPAA believes the insurance industry's actions will prove damaging to health consumers, since there is no one drug which works for every patient. "Until drugs are considered to be equivalent, a patient should never be switched from one medication to another. The heart medications or insulin suitable for one person could prove harmful -- even lethal -- to another. It is impossible for decision-makers at insurance companies to dictate the medical needs of all members. Individual doctors should be afforded that right and responsibility," Van Pelt concluded.

The International Patient Advocacy Association provides resources and support to individuals with chronic diseases. The IPAA brings patients together to network in person, by telephone, or by mail. On a pro bono basis, the association helps appeal when insurance companies deny access to treatment.

The association also helps with employment law issues and other legal matters regarding medical records, patient confidentiality, database forms, etc. In addition, the IPAA provides a wide range of information on treatment options and other developments in the management of genetic disorders and other disease states.

--30--ahc/sf*

CONTACT: International Patient Advocacy Association Lenny Van Pelt, 800/944-7823, ext. 4037 or The Perry Group Kassy Perry or Stephanie Yoder, 916/658-0144

980701
BW980704

Copyright © 1998 - Business Wire. All rights reserved. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Business Wire, Permissions Desk, Business Wire, 1185 Avenue of the Americas, 3rd Floor, New York, NY 10036; Tel: (212) 575-8822; FAX: (212) 575-1854. http://www.businesswire.com.

AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from Broadway Cares/Equity Fights AIDS, Elton John AIDS Foundation, the National Library of Medicine, Pacific Life Foundation and donations from users like you.

Always watch for outdated information. This article first appeared in 1998. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1998. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .