A California consumers group has urged officials to block PacifiCare Health Systems' proposed acquisition of FHP International, alleging PacifiCare skimps on prescription drugs.
"PacifiCare patients can expect only more of the same care-cutting if the company is permitted to expand," Consumers for Quality Care said in a press release.
"PacifiCare no longer pays for effective, high-cost, anti-psychotic drugs such as . . . Risperdal and Prozac," the advocacy group charged.
The group likened the situation to PacifiCare's omission of the chickenpox vaccine Varivax from its formulary until the state ordered the HMO to include the vaccine (Aug. 5, 1996, p. 104).
But Alex Gilderman, manager of clinical services at PacifiCare's pharmacy benefit management subsidiary, denied that PacifiCare won't pay for Risperdal and Prozac.
Executives said the HMO had never refused to cover Varivax but had delayed including it in its formulary because of clinical concerns.
Prozac was dropped from the HMO's formulary a year ago upon the recommendation of its pharmacy committee, in favor of Paxil and similar, less-expensive drugs with "equal efficacy," Gilderman said.
PacifiCare still pays for Prozac for enrollees who have been stabilized on the drug and for new prescriptions if the patient's doctor requests it.
No doctors have requested Risperdal be included in the HMO's formulary, but PacifiCare regularly pays for prescriptions for the drug, Gilderman said.