Lawmakers weigh barring insurers from removing drug coverage while policies in effect

Feb. 07--Private health insurers would not be able to yank prescription drugs from their approved-for-coverage lists during the middle of a health insurance policy term, if a proposed ban becomes law in Florida.

At Tuesday's meeting of the state Senate Banking and Insurance Committee in Tallahassee, Vero Beach mom Margaret Mitchell recounted going to her pharmacy and learning the price of her daughter's asthma inhaler jumped from $15 or less to $400 or $500 because their insurer suddenly decided not to cover it anymore.

That's happened as often as four or five times in a year, she said. Her pharmacist would then scan the insurer's coverage list, "find the one the insurer wouldn't reject and send me with that name back to the pediatrician to get the prescription for that medication and also to ask the pediatrician, "Is this going to work for my daughter?'"

Separate trips to a specialist are also needed, she said, to have them approve it, too and then in two weeks ... to make sure that medication was working."

"That's three days in a month I have to be off work."

Kayla Abramowitz, 14, of North Palm Beach, said she takes daily, weekly and monthly medications for medical issues including juvenile arthritis. The teen, who is also "Senior Kid Officer" for the Arthritis Foundation, urged the committee to advance a bill sponsored by state Sen. Debbie Mayfield, a Republican from Melbourne.

"If one of [the medicines] were taken away from me, I wouldn't be able to do the things I love including going to school and advocating here," she said.

Mayfield said the bill "would simply require commercial health plans to deliver on the pharmacy benefits that they marketed and sold to consumers during open enrollment. They can add new generic drugs or any new product they like. They just can't make the original list more restrictive."

Insurers would be able to change their lists of covered drugs during open enrollment periods, or during a plan term if the Food and Drug Administration issues a health warning about the drug.

Several interest groups at the meeting said they supported the bill, including AARP, Florida Pharmacy Association, American College of Physicians, American Cancer Society, Florida Medical Association and Florida Dermatology Association.

Michael Ruppal, executive director of the AIDS Institute, said that for HIV/AIDS patients, "stopping or interrupting treatment at any time is potentially a death sentence by interfering with their ability to fight the virus."

Opposing the bill, Audrey Brown, president and CEO of the Florida Association of Health Plans, said it would have barred health plans from adding a lower-cost alternative to the epinephrine injector known as EpiPen to their lists of preferred prescription drugs after approval by the FDA in mid-January.

It also would have barred health plans from pulling the drug Vioxx when it became apparent patients were suffering adverse effects while FDA warnings were still pending, Brown said.

And Brewster Bevis, spokesman for the Associated Industries of Florida, said his organization believes the proposed law would lead to higher health insurance prices because insurers would no longer be able to remove drugs if their prices skyrocket.

Approved 6-1 by the Banking and Insurance Committee, the bill heads to the Senate's Health Policy and Rules committees next. A companion version in the House is sponsored by Ralph Massullo, R-Beverly Hills.

rhurtibise@sun-sentinel.com, 954-356-4071, twitter: twitter.com/ronhurtibise

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