Blue Cross to Reimburse Some Customers Who Use AIDS Drug

Blue Cross of California, the state’s largest health insurer, says its 1.5 million customers with pharmaceutical coverage will be eligible for reimbursement for prescribed use of the AIDS drug AZT. But the company said its 2 million customers without pharmaceutical coverage will not be reimbursed.

The announcement was the first by a major health insurer concerning payment for the drug azidothymidine.

AZT was approved last Friday by the U.S. Food and Drug Administration for treatment of patients with acquired immune deficiency syndrome. Tests have shown that the drug can ease symptoms of AIDS and perhaps prolong the lives of patients, but it is not a cure.

AZT treatments cost from $7,000 to $10,000 a year, Dr. Brian Gould, Blue Cross vice president and medical director, said Wednesday.

The Blue Cross decision drew criticism from Peter Groom, staff counsel for the California Department of Insurance, who said that the state agency wants insurers to seriously consider broader coverage of AZT costs on humanitarian grounds. He said such coverage could save insurers money in the long run by reducing hospitalization costs.

“A year’s supply of AZT is considerably cheaper than a few days in the hospital in many instances,” said Groom, who is drafting a memorandum advising insurers to pay for AZT for all customers. “The bottom line in health insurance coverage is keeping the person alive. A responsible insurance carrier should consider (paying) the cost of AZT whether or not prescription drugs are covered,” Groom added.

FDA approval of the drug was followed by a state Department of Health Services announcement that AZT prescriptions would be paid for under the Medi-Cal program for indigent AIDS patients.