A California judge tentatively upheld a state law giving regulators the authority to dictate which prescription drugs HMOs must cover, a ruling health officials called a major victory for patients. The preliminary decision by Judge Emily Vasquez in Sacramento Superior Court is the latest in a tug of war between insurers and the state Department of Managed Health Care over so-called lifestyle drugs. The lawsuit was brought by Blue Shield of California, San Francisco, in 2001 after the department forced it to pay for a weight-loss drug to treat a morbidly obese patient. The department had determined that the drug, although excluded from the woman's insurance policy, was medically necessary and fined Blue Shield $270,000 for having denied it. The judge initially agreed with Blue Shield, then reversed her decision when the state Legislature passed a law in 2002 requiring HMOs to seek the agency's approval before excluding any medication from members' policies. Blue Shield argues that the case involves a policy signed years before the law went into effect. A final ruling is expected within 30 days. In July 2002, another California judge ruled that the department could not require Kaiser Permanente, Oakland, Calif., to cover the anti-impotency drug Viagra. -- by Laura B. Benko
Calif. bid to oversee drug coverage gains ground
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