Tuesday, June 29, 1999

HMSA lowers
coverage for drugs

Starting Thursday, about
130,000 patients will have
to pay more for medicine

By Helen Altonn


About 130,000 employees with Hawaii Medical Service Association drug benefits will pay more for prescription medicine starting Thursday.

The cost may be considerably more in cases where people use "nonpreferred brands" -- medicines that aren't on HMSA's select drug list.

The Hawaii Coalition for Health, which has a Division of Pharmacy, is looking into the new drug plan.

"It may be absolutely fair and up front. We don't know yet," said Dr. Arleen Jouxson-Meyers, coalition president. "We're uncertain how drugs got on the formulary."

HMSA officials said they worked with employers on the new drug plan to try to deal with spiraling drug costs and prevent them from dropping coverage for their employees under financial pressure.

About 90 percent of HMSA's 600,000 members have a drug benefit as part of their group health plan.

The new rates will apply Thursday to groups with 100 employees or fewer -- a total of about 130,000 employees, said HMSA spokesman Chuck Marshall.

He said the state government, some federal plans, large private organizations, the Hawaii Government Employees Association and United Public Workers have the option of picking up the new plan for HMSA members during their enrollment periods, and the unions are taking it.

HMSA Senior Vice President Cliff Cisco said the new plan has three tiers for member co-payments.

For most groups, co-payments will go from $3 to $5 for a 30-day supply of generic drugs, from $7 to $10 for preferred brand drugs, and $10 for non-preferred brands, plus a differential.

Costs for HGEA and UPW workers will go from $3 to to $5 for a 30-day supply of generic drugs, from $10 to $15 for preferred brands and from $10 to $15, plus a differential, for non-preferred brands.

The differential is the difference between the normal cost of a drug for someone without drug coverage and the average cost of equivalent alternatives.

Marshall cited several examples to show how the differential works, stressing that the costs will vary for members, depending on the dosage and supply.

The most-utilized drug not on the select list is Norvasc, used for high blood pressure, he said.

The average differential would be $15, plus the $10 co-payment for a total of $25 for most groups. The differential also would average $15 for HGEA and UPW members, and with a $15 co-payment, the total would be $30.

He said prescription drug costs "are increasing at an alarming rate of 18 to 20 percent," largely because of direct consumer advertising by the drug industry.

But members' co-payments and benefits "have been flat for many years," Cisco said. "To avoid the prospect of employers dropping pharmacy coverage to employees, we're offering the solution of having members pay increased co-payments."

With the brand name planted in their minds, people are asking for the most expensive drugs, said Chuck Marshall, HMSA spokesman. "Sometimes, there is no adequate alternative, but in many cases there are," he said.

Dr. Henry T. Oyama, HMSA medical director, said, "The purpose here is not simply to moderate the cost of pharmacy benefits. The ultimate goal is to get members to discuss their prescription options with their physicians, and possibly select a less costly alternative."

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