Managers of health plans, always looking to save a few bucks, are taking a hard look these days at the prescription drug programs they offer to their members. While consumer prices are climbing at less than 2% a year, drug prices are rocketing ahead at an inflation rate of 10% and more.

The emphasis on cost control can lead to frequent changes in formularies, the lists of drugs that a health plan will pay for. If your high blood pressure medicine is on the HMO's formulary, you can get the prescription filled for just a modest co-payment. But if the drug is dropped from the approved list, you may be hit with the full retail price when you go to the pharmacy. For many people of modest incomes, particularly elderly men and women who use multiple prescriptions, it can be a big financial hardship when the formulary changes.

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But Californians got new protections last month when a new state law on health plan formularies went into effect. The law guarantees members of HMOs the right to continue taking a medication--as long as their doctors keep prescribing it. And the HMO can't charge you extra for that drug.

HMOs "use formularies to control their drug expenditures by limiting the number of drugs a plan will cover, using financial incentives to encourage the use of certain drugs, and employing compliance programs that encourage or require physicians to prescribe formulary drugs," the General Accounting Office said in a report issued last month. The GAO, the investigative arm of Congress, studied 16 HMOs serving Medicare beneficiaries in Los Angeles, Miami and Philadelphia.

The HMOs dropped 63 drugs from their approved lists, including those used to treat hypertension (high blood pressure), depression, high cholesterol and ulcers. There was particularly high turnover in hypertension drugs.

"Many older Americans choose managed care specifically for prescription drug coverage," said Sen. Charles Grassley (R-Iowa), chairman of the Senate Aging Committee, which released the GAO report at a hearing last month. "No one should be in for an unpleasant surprise at the drugstore."

Switching prescription medications can be a dicey proposition. It is not the same issue as going from a brand-name drug to a generic equivalent, which is the identical chemical compound. Using a generic instead of a brand-name drug is like buying a Ford or a Chevy or a Toyota, said Edgar Arriola, director of the drug information center at UCLA Medical School. "All of them have four wheels and they get you where you want to go by driving."

But drug substitution is like changing from a car to a bicycle or a motorcycle. "There is no table [the doctor] can look at that says, 'If you take 10 milligrams of drug X for high blood pressure, you need 15 milligrams of drug Y,' " said Arriola.

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For many patients, substitution isn't a problem. A doctor selects a dose close to the old one and adjusts it as the patient responds. But for a significant minority of patients, notably elderly people with multiple health problems, drug switching could cause severe problems.

Someone with high blood pressure and kidney problems, for example, might react badly to a new hypertension drug, sending the patient's blood pressure "through the roof," said Arriola.

The California law will help patients and their doctors avoid those dangerous reactions. The law applies to all HMOs, including ones that serve the Medicare population, those older than 65 and the disabled of all ages.

The protection is guaranteed under Section 1367.22 of the California health and safety code. The enforcement agency is the Department of Corporations, which regulates HMOs. Patients and their doctors should be aggressive in asserting the right to keep getting the prescriptions vital for good health. "It may be necessary for physicians to remind the [health] plan of its legal obligations," a Corporations Department official said. If the health plan refuses to follow the rules, the department will take complaints at (800) 400-0815.

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There is good financial news for people receiving benefits under the Social Security disability program. The Social Security Administration just raised the amount disabled workers can earn and still remain eligible for benefits. The earnings limit, $500 a month, was boosted to $700 a month, starting July 1. The change will enable them to earn more money while keeping the Medicare coverage they are entitled to.

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Last month I wrote about the complex, multiple array of health insurance programs for poor children and families. Here is another one to add to the list: Access for Infants and Mothers, or AIM. Women who don't have private medical insurance and make too much money to qualify for Medi-Cal are eligible for AIM. To enroll, the woman must not be more than 30 weeks pregnant. The program pays for prenatal care, delivery of the baby and coverage for the child up to age 2. Care is provided through HMOs. The program is open to those with family incomes of between 200% and 300% of the federal poverty line or, for a family of three, an annual income of $27,761 to $41,460. The family must pay a premium of 2% of income for the first year. The next year's premium is $100, or $50 with proof the infant was immunized.

Generally, it is available for those without private medical insurance. But AIM also applies if the family has private insurance, although there is a deductible for more than $500 for pregnancy costs. AIM information is available at (800) 433-2611.

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This column gets lots of questions on nursing homes, Medi-Cal and long-term care insurance. A series of free classes on these topics, plus estate planning, wills and living trusts, will be held in September and October, sponsored by H.E.L.P., a nonprofit group based in Torrance. For information and reservations, call (310) 533-1996.

Question: If you have long-term-care insurance and you use up the lifetime amount, will Medi-Cal kick in?

Answer: The insurance is a planning tool for middle-class people who want to preserve some of their financial assets for their children. The best policies offer a pool of money that can be used in various circumstances: for daily costs at the nursing home, to hire aides at home, or to pay expenses in an assisted-living facility where a person has one's own apartment but eats meals in a communal dining room. The government program, Medi-Cal, pays the bills in nursing homes only after a person's assets have been used (stocks, bonds, cash) and "spent down" to $2,000. While the long-term insurance is being used to pay the bills, the financial assets of the person in the nursing home may be distributed, perhaps to children and grandchildren. However, the law is highly complex, and families should consult an attorney specializing in elder care topics.

We welcome your suggestions, questions and tips on health care issues. Write to Bob Rosenblatt, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053. Or e-mail to bob.rosenblatt@latimes.com.