[Clipping: Health maintenance plan drops coverage of AIDS drug] Part: 1 of 2
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Health maintenance plan drops coverage of AIDS drug
By Lorraine lannello
OF THE TIMES HERALD STAFF
A health care plan that covers people
in Dallas and Fort Worth will no longer
provide coverage of an experimental
drug treatment believed to help prevent
a form of pneumonia deadly to people
with AIDS.
Sanus Texas Health Plan, a health
maintenance organization based in Ir-
ving, on Jan. 1 stopped paying for aero-
solized pentamidine, which is used to
help prevent pneumocystis carinii pneu-
monia, a leading cause of death amongAIDS patients.
Stan Alekna, executive director of
Sanus, said the company will resume
coverage of the experimental drug only
if it is approved by the Food and Drug
Administration for use.
"It doesn't pay to be a good guy,"
Alekna said, referring to criticism of
Sanus for discontinuing the coverage.
"In anticipation of its approval, we tried
to provide advance coverage of it. We've
been helping them without any require-
ment to. We can no longer continue to
do so."
To continue to offer coverage of theI
drug would open a Pandora's box of re-
quests for coverage of other experi-
mental treatments, Alekna said.
"This had nothing to do with AIDS,"
Alekna said. "To be fair to everybody,
we backed off."
Sanus informed physicians in a series
of letters that the coverage was
"exceptional" and would be withdrawn
without FDA approval, Alekna said. He
said he knows of no other health main-
tenance organizations that cover the
experimental pentamidine treatments.
The Food and Drug Administration in
October 1984 approved the use of pen-tamidine for injection but not the aero-
solized form, which remains under
experimental status, said Janet Mc-
Donald, an FDA consumer affairs
officer.
However, FDA Commissioner Dr.
Frank Young in a speech last year urged
insurers to consider paying for experi-
mental therapies out of compassion,
McDonald said.
"It's a judgment call," McDonald said.
Providers of care for people with ac-
quired immune deficiency syndrome are
Please see DRUG, B-2
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Iannello, Lorraine. [Clipping: Health maintenance plan drops coverage of AIDS drug], clipping, January 6, 1989; (https://texashistory.unt.edu/ark:/67531/metadc1584286/m1/1/?q=%22Business%2C+Economics+and+Finance+-+Insurance%22: accessed July 9, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Special Collections.