The Willow Glen Resident

HMO buyers beware

By Howard Owens

If something looks too good to be true, it usually is. This cliché is familiar to Generation Xers, Baby Boomers and those of us who raised our children long before Ozzie and Harriet tied the knot.

Unfortunately, Madison Avenue continues to market everything from anti-bacterical toys to weight-loss programs with claims that are clearly too good to be true. If awards were being handed out to marketing teams who best mislead with a turn of phrase, it would have to go to the clever folks who do the work for California's leading HMOs.

I hope senior citizens won't be fooled by a series of recent SecureHorizons newspaper ads that claim that they "helped initiate the idea of a health-care plan that would specifically serve the needs of Medicare recipients." Their goal is to sign up more unsuspecting senior consumers for their health plan by painting a rosy picture of what you get for next to nothing.

Here's what the advertisement fails to mention:

SecureHorizons is owned by PacifiCare, an HMO often criticized by both consumer- and patient-advocacy groups for its drug-switching policies and its restrictive access to disease specialists.

In fact, the National Alliance for the Mentally Ill ran full-page ads in many California newspapers criticizing PacifiCare because medications like Prozac and Risperdal are not covered for members suffering from clinical depression and schizophrenia.

Most recently, the Congress of California Seniors warned their members that a number of important medications taken by seniors, including drugs to treat arthritis, high blood pressure, depression and diabetes, are not available to members of SecureHorizons.

Mental illnesses, especially depression, are common among senior citizens, making PacifiCare's decision critical for millions of people in California. But the urgency surrounding this issue is much broader than restricting medications for mental illnesses.

PacifiCare has restricted access to a variety of medications that are widely utilized by senior citizens, including Day Pro, a medication for arthritis; Glucotrol XL and Humulin, two medications for diabetes; and several heart and blood-pressure medications, including Prinvil and Vasotec.

Even more frightening for seniors? Two medications for the treatment of Alzheimer's disease, Aricept and Cognex, are not even offered by SecureHorizons.

Many of these medications mean the difference between life and death for the elderly. Unfortunately, SecureHorizons believes it knows more than physicians about the medical needs of individual patients.

The power over prescriptions should be returned to the attending physicians as soon as possible. Only the doctors know which medications suit individual patients. Many medications, while effective for some patients, cause adverse and allergic reactions in others. Unfortunately, physicians now are being controlled to a degree by managed-care organizations. And many, because of time constraints, are not willing to argue with insurance groups over specific medications.

It's sad --and scary--for senior citizens, many of whom rely on appropriate medication for quality of life.

HMOs like PacifiCare and SecureHorizons should end the concept of restricted formularies. While the evolution of managed care has provided some benefits, both financially and medically, restricting access to proven medication is a step in the wrong direction.

Howard Owns is legislative director of the Congress of California Seniors, a 500,000-member organization that aims to improve quality of life for seniors and their families.

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