SHOULD A LIFESAVING Rx DRUG INVALIDATE HEALTH INSURANCE?

Published Online: Thursday, February 1, 2007

A prescription for Lipitor (atorvastatin) could lower patients' cholesterol levels, sharply reduce the chance of a heart attack or stroke, and even save their life. It could also render them ineligible for health insurance coverage.

A new analysis of nonpublic underwriting guidelines used by 4 of the largest health insurers in California confirms that these companies routinely deny coverage to individuals solely on the basis of the medications they are taking to control their health problems. In addition to Lipitor, many other widely prescribed drugs such as Allegra (fexofenadine HCI), Celebrex (celecoxib), and Prevacid (lansoprazole) may lead to rejection of an individual's application for health insurance coverage.

The review, which was undertaken as Gov Arnold Schwarzenegger (R, Calif) was putting the final touches on a major new proposal to reform the state's health care system, found that prescriptions for 8 of the 20 topselling prescription drugs in the United States could leave individuals uninsurable at one or more of these companies.

The underwriting practices examined included those of Blue Cross of California, the state's leading seller of individual policies, Blue Shield of California, PacifiCare Health Systems Inc, and Health Net Inc. Although such restrictive underwriting practices are legal in California, critics of the process consider these activities to be inappropriate and are urging Gov Schwarzenegger to put an end to this form of health care "cherry picking."




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