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New York, December 10, 1997

Governor George E. Pataki and Superintendent of Insurance Neil D. Levin today announced that the State Insurance Department will be directing the state’s HMOs to immediately stop offering a rider requiring policyholders to pay a higher co-payment if they use self-injectable drugs. The Department is requiring that the co-payment for injectable drugs be the same as every other co-payment under the HMOs prescription drug plan.

This action is being taken after consumers and others complained that HMOs in Western New York had implemented reduced coverage for self-injectable drugs by increasing deductibles to unacceptably high levels.

"This decisive action puts HMOs on notice that we will not allow the most vulnerable policyholders to be left unprotected," Governor Pataki said. "Our action will prevent those people with serious diseases from being forced to pay significant amounts of money for self-injectable drugs at a time when they can least afford additional costs."

"We are telling the HMOs in Western New York and throughout the entire State that they must agree to cease selling drug coverage with a unique co-payment for self-injectable drugs, and must terminate existing contracts with such a requirement as soon as possible," said Superintendent Levin. "If this voluntary compliance is not forthcoming, the Insurance Department will promptly pursue administrative action."

"The Governor's leadership on this issue will help people with neurological diseases and cancer, hemophiliacs, and children with growth problems get the prescription drugs they need," said State Health Commissioner Barbara A. DeBuono. "People need these drugs to improve the quality of their lives, and often times, just to survive. However, without appropriate insurance coverage, the cost of these life-saving drugs can be prohibitive. Governor Pataki has made these drugs affordable for the people who need them most."


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