Washington State Insurance Commissioner Senn Says She Will Write New Rules to Help Consumers Decode Their Prescription Drug Coverage.

News Editors, Health/Medical Writers

OLYMPIA, Wash.--(BUSINESS WIRE)--June 21, 2000

State Insurance Commissioner Deborah Senn plans to write new drug-coverage rules under a newly-passed individual-market bill to help consumers know what drugs their coverage pays for and which it doesn't.

"I held hearings across the state over the past two months to solicit testimony on problems and concerns linked to prescription drugs," Commissioner Senn said. "One of the recurring themes in all the hearings was the problem ordinary people have trying to figure out their drug coverage."

Commissioner Senn said the new rules resulted from two years of work by a Prescription Drugs Task Force organized by her office. The task force developed draft rules to address the consumer issues identified as priority concerns.

"With the passage of the current law, we are ready to move forward and put those remedies in place," Commissioner Senn said. "As I have said many times during the past eight years, an informed consumer is a well-armed consumer."

Drug coverage is defined in a policy's "formulary," but those sections are often difficult for the layman to understand and decipher. In addition, they are sometimes hard to pinpoint inside complex policy language.

"In fact, most of us have to find out what our drug coverage is the old-fashioned way," Commissioner Senn said. "We go to the drug store and have the pharmacist tell us we're not covered."

Commissioner Senn said insurance carriers should be proactive and help shine a light on their coverage to make sure consumers understand how it works, what it costs, how to use it effectively, and what to do when there are problems.

The earlier draft rules centered on a set of questions about drug coverage for companies to answer at the time a health insurance policy is purchased. Commissioner Senn said she thinks that list is still a sound approach.

The draft rules required carriers' contracts to include simply worded and direct replies to a series of common-sense questions, such as:

-- Does this plan limit or exclude certain drugs my health-care

provider may prescribe, or encourage substitutions for some

drugs?

-- When can my plan change the approved drug list?

-- What should I do if I want a change from limitations,

exclusions, substitutions or cost increases for drugs

specified in this plan?

-- How much do I have to pay to get a prescription filled?

EDITORS: To comment on the rule proposal, people may send comments in writing (Insurance Commissioner Deborah Senn, P.O. Box 40255, ATTN: Rules/Kacy Brandeberry, Olympia, Wash. 98504-0255) or visit the OIC Internet Web Page at http://www.insurance.wa.gov (An informational copy of the previous draft rules also is posted on the page.) For more information, call Kacy Brandeberry of the Rules staff at 360/664-3784.