A controversial change in drug insurance coverage by Harvard Pilgrim Healthcare has already sparked multiple lawsuits and a revision of the coverage from the insurance company, but pharmacists doubt the promised new policy will be carried out.
"We definitely have concerns about how they're going to apply the policy," said Todd Brown, executive director of the Massachusetts Independent Pharmacists Association.
The policy, changed to limit coverage to compounded drugs that are medically necessary, calls for a review process to determine the medical necessity of the drugs. This comes after the insurer sent out letters to patients, pharmacists and doctors clarifying that the policy would not automatically reject claims for compounded drugs.
A spokeswoman said Harvard Pilgrim is committed to reviewing requests within 48 hours, but have already completed many reviews in less time.
"It is efficient and effective, and we turn around responses quickly," said Joan Fallon, spokeswoman for Harvard Pilgrim.
But Brown said many applications have been immediately rejected, including some by HPHC representatives unaware of the revised policy. He said that less than one-third of the claims have been approved so far.
A motion for a preliminary injunction of the policy was denied in Norfolk Superior Court.
A spokesman for the Department of Consumer Affairs, which includes the Division of Insurance, said the department would be monitoring the marketplace to ensure the policy is implemented correctly.
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