Maccabi HMO Asks High Court to Examine Policies on State-subsidized Drugs

The Maccabi health maintenance organization petitioned the High Court of Justice earlier this week to instruct the Health Ministry to set up a national committee in charge of adding drugs to state-subsidized health services. The HMO also is demanding that the ministry convene the committee in charge of state-subsidized drugs and services at least once a month, instead of once a year.

Last year, the Health Ministry issued regulations to the various HMO committees dealing with requests for treatments that are not included in the state-subsidized drugs and services. The regulations were made on the basis of the state comptroller's report in May 2006 that found failures and flaws in the HMOs' drug registration, and in the way HMOs pass members' requests for unsubsidized treatments on to the committees in charge of their cases.

A few days before the petition was filed, Deputy Health Minister Yaakov Litzman said the ministry had found surplus funds in the HMOs' budgets. He said he would take that money back and use it to reduce the price HMO members have to pay for subsidized generic drugs.

The HMOs objected to this move, claiming the ministry's calculation was partial and they had no surplus money in the drugs budgets. They said reducing drug prices would force them to close down vital services.

Maccabi officials said the petition has nothing to do with Litzman's decision.

"Maccabi is doing everything it can to make it difficult for its members to receive vital medicines," ministry officials said in response to the petition, accusing Maccabi of denying its obligations to its members.

Maccabi argues in the petition that ministry procedure requires the HMO to consider adding a drug to its internal list of subsidized services if one of its members requests a drug that is not state-subsidized. The drug is then to be made available to all the HMO's members.

This procedure circumvents the national committee in charge of subsidized drugs and services and runs contrary to the state health insurance law, the petition says.

Maccabi was one of the first HMOs to operate committees authorized to add drugs to its subsidized treatments and earmarked an annual NIS 10 million a year for this purpose. The HMO set up a 20-member technological panel, headed by Maccabi's general manager, which used to meet once every six months, the petition says.

The committee decided over the years to include drugs for cancer and epilepsy, as well as cardiological technologies, in its subsidized services before they were made part of the state-subsidized health services.

The panel halted its work two-and-a-half years ago due to Maccabi's financial deficit.

Maccabi's committee dealing with requests for unsubsidized drugs meets at least twice a week and approves about 50 percent of the requests, the petition says.

The petition says the ministry convenes the committee for subsidized drugs only once a year, yet demands the HMOs do so once a week.

"The Health Ministry would do better to set up a national committee for requests for unsubsidized treatments and operate them at its own expense, rather than shifting the responsibility for providing unsubsidized treatments onto the HMOs," the petition states.

Justice Hanan Meltzer has instructed the Health Ministry to respond to the petition within three weeks.