SHOULD A LIFESAVING Rx DRUG INVALIDATE HEALTH INSURANCE?

Pharmacy Times, Volume 0, 0

A prescription for Lipitor (atorvastatin)could lower patients'cholesterol levels, sharply reducethe chance of a heartattack or stroke, and even savetheir life. It could also renderthem ineligible for health insurancecoverage.

A new analysis of nonpublicunderwriting guidelines used by4 of the largest health insurers inCalifornia confirms that thesecompanies routinely deny coverageto individuals solely on thebasis of the medications they aretaking to control their healthproblems. In addition to Lipitor,many other widely prescribeddrugs such as Allegra (fexofenadineHCI), Celebrex (celecoxib),and Prevacid (lansoprazole) maylead to rejection of an individual'sapplication for health insurancecoverage.

The review, which was undertakenas Gov Arnold Schwarzenegger(R, Calif) was putting thefinal touches on a major newproposal to reform the state'shealth care system, found thatprescriptions for 8 of the 20 topsellingprescription drugs in theUnited States could leave individualsuninsurable at one ormore of these companies.

The underwriting practicesexamined included those of BlueCross of California, the state'sleading seller of individual policies,Blue Shield of California,PacifiCare Health Systems Inc,and Health Net Inc. Althoughsuch restrictive underwritingpractices are legal in California,critics of the process considerthese activities to be inappropriateand are urging Gov Schwarzeneggerto put an end to thisform of health care "cherry picking."