California Agency Denies Kaiser Permanente Request To Cap Prescription Drug Benefits, Citing Cost to People With HIV

The California Department of Managed Health Care last week rejected a request by Kaiser Permanente to place caps as low as $500 on prescription drug coverage for some individual and small-group health plans, the Los Angeles Times reports. Under a bill passed this year, the department has the "explicit authority to regulate" HMO drug benefits. DMHC Director Daniel Zingale said the department is concerned about rising prescription drug costs but added that insurers' cost-saving plans should not jeopardize patients' health. "No one with heart disease, cancer, diabetes or HIV should be denied lifesaving drugs," Zingale said, adding, "The Kaiser proposal could force many people with HIV, under the impression that their health-care investment covers lifesaving drugs, to choose between food and medication," Zingale wrote in a letter to Kaiser Chair and CEO George Halvorson. Although state law does not require insurers to cover prescription drugs, those that choose to do so must meet certain minimum standards, including coverage of diabetes treatments, contraceptives and pain management medications. Kaiser Permanente spokesperson Matthew Schiffgens said the company last Tuesday withdrew its request for the caps, a day before Zingale's letter was sent. Schiffgens said Kaiser still feels such limits are "reasonable, given the current realities of medical economics," the Times reports. "We think that these are useful and responsive tools for balancing the rapidly escalating cost of pharmaceuticals and the imperative to keep insurance premiums affordable," Schiffgens added. Zingale said the DMHC plans to conduct a study on prescription drug caps, including when they might be appropriate and at what level they should be set (Ornstein, Los Angeles Times, 10/11).