HMO Limits On Doctor Rxing "Open To Abuse"

When health maintenance organizations started up in the USA ascompetitors to traditional health insurance, their benefits for prescriptions were often "richer, in an effort to get patients to use drugs and thus head off more serious illness and hospital stays," according to an article in the Wall Street Journal. However, the report also notes that as the costs of drugs for HMOs are increasing (they advanced approximately 13% last year), the organizations are searching for ways to reduce their pharmaceutical costs.

Some HMOs are increasing consumer co-payments for drugs, while others are restricting which products they cover, says the WSJ. And, in the latest development, many HMOs are giving groups of physicians a monthly drug budget, penalizing them if they go over it and letting them share in the savings if they stay below it.

"Pharmacy Risk-Sharing" The HMOs contend that such "pharmacy risk-sharing" gives doctors an incentive to consider the cost-effectiveness of the drugs they prescribe, says the report, which notes that the HMO argument is that as long as somebody else is paying "physicians won't take the time to research whether costlier drugs are worth the extra money."