Gutierrez introduces formulary rights bill

Congressman Luis Gutierrez (D-IL) introduced a bill that would provide more information about a health maintenance organization's formulary to its enrollees.

The Patients' Formulary Rights Act of 1999 would protect HMO enrollees by requiring disclosure of:

• Formulary practices prior to enrollment, additions and deletions to formularies.

• A complete list of all covered drugs.

• Limits on annual and lifetime payments.

• Copayments for formulary and non-formulary medications.

"Such notification will be required at the time of the patient's enrollment, and a full and accurate notification of any changes in the formulary will also be necessary," said Gutierrez. "Such an alert will be issued at the time that any such changes occur and will be repeated in an annual update to enrollees."

In addition, the bill would require notification to enrollees of any changes and allow for continuity of care by enabling enrollees to continue on prescribed medications for treatment of the same conditions. The legislation would also require health insurance firms to disclose to their enrollees if they engage in the practice of drug switching. Drug switching is the act of dispensing a drug product that has a different active ingredient from the one prescribed, but which is in the same pharmacological or therapeutic class with similar therapeutic effects.

"The practice known as 'drug switching' is a dangerous example of patients being kept in the dark about the choices being made by others that will determine their health," said Gutierrez. "In far too many cases, 'managed' care has meant that it is the information available to millions of Americans and their doctors that is being 'managed.'"

"This bill, if enacted, would ensure that prescription medications are dispensed for one reason and one reason only: for the sake of maintaining a patient's health – not for the sake of adding to a company's profits," added Gutierrez.

The Patients' Formulary Rights Act is a direct result of a recent California investigation into HMO drug denials prompted by California politicians and Citizens for the Right to Know, a consumer group.

"Congressman Gutierrez's legislation demonstrates the power of the consumer and substantiates the personal experiences of Californians who have been victims of HMO drug switching and denials," said Elizabeth Helms, steering committee member of Citizens for the Right to Know. "We applaud Congressman Gutierrez for his efforts on behalf of patients and consumers."

If passed, the bill would apply for plan years on or after Jan. 1, 2001. PR