Connecticut sues HMO

Connecticut Attorney General Richard Blumenthal has filed a lawsuit against Physicians Health Services, Shelton, a subsidiary of L.A.-based Foundation Health System and the state's largest managed care company, alleging its pharmaceutical policies pose potentially harmful and dangerous restrictions on consumers.

"Violating its moral and legal duties – to put patients first – PHS has forced people to use less effective medicine simply so it can make more money," Blumenthal said. "Through a variety of tactics – coercing doctors, complicating appeals, concealing information – PHS has cut access to pharmaceutical drugs. It has pressured countless people to switch from drugs originally prescribed by doctors to others preferred by PHS, solely because their costs are lower."

The suit, filed in U.S. district court in Hartford, charges PHS of authorizing prescription drugs that are inexpensive because the company has received discounts and rebates from pharmaceutical companies in exchange for placing those drugs on the PHS formulary.

The suit also accuses PHS of causing patients serious harm, including pain and suffering associated with inadequate medication, delayed recovery from medical conditions, and substantial and unnecessary out-of-pocket expenses, by refusing to cover medically necessary prescription drugs.

"PHS failed to put patients first – and to tell them truthfully about their rights and its formulary restrictions," Blumenthal said. "Patients were led to expect benevolent oversight. Instead, they encountered an overpowering bureaucracy – bent on switching them from prescribed drugs to less costly, less effective preferred drugs, without minimal disclosure and notice."

Blumenthal is asking the court to order PHS to reform its drug formulary system to ensure that patients receive medications that are safe and effective and to require the company to provide patients with written denial notices and instructions on how to appeal denials. PR