In a move aimed at offsetting rising drug
prices, one of the nation's leading HMOs is forcing members to
split a large pill of some anti-depressant pills in half in order
to get their daily dose.
Critics, including some doctors, say the action by
UnitedHealthcare takes penny-pinching by health maintenance
organizations to new extremes and say it could be dangerous.
"It comes across as very cheap on the part of the health
plan," said Dr. Ian Bushell of Family Medicine Associates of Cary.
"It's not so much a hassle for me. The patients are the ones who
have to break a pill in half."
United says it will pass along its savings by keeping premiums
low.
United recently sent letters to doctors, members and pharmacies
outlining the new nationwide policy.
The HMO now says it won't pay for certain dosages of Zoloft,
Paxil and Celexa, three popular anti-depressants. For example, it
no longer will cover 50-milligram tablets of Zoloft, a commonly
prescribed daily dosage. Instead, the HMO will cover 100 mg tablets
and order doctors to prescribe half a pill per day.
A 100 mg pill of Zoloft costs 7 cents more than a 50 mg pill,
according to Dr. Lee Newcomer, senior vice president for health
policy with United.
Covering only 100 mg tablets and having patients split them will
lower the cost for the same amount of medicine significantly, he
added.
A 30-day supply of the equivalent of 50 mg per day, under the
new policy, will cost United $36.15, down from the $70.20 it pays
now.
"It seemed to be a painless way to keep drug costs down,"
Newcomer said.
Daniel Garrett, executive director of the N.C. Association of
Pharmacists, said smaller HMOs have tried similar policies, but
this is the first time he has heard of a national HMO requiring it.
"For some patients, you could end up with dosing errors,"
Garrett said.
