Clalit Health Services, the largest health fund, charges its members 45 percent more than other insurers, such as Kupat Holim Meuhedet, according to an independent study in the current Pharma Drug Bulletin. The study was edited and published by Dr. Philip Sax, a Jerusalem-based researcher who supplies information and analyses to Israeli health care professionals and policymakers and is an adviser to the World Health Organization. He reported that for 40 types of frequently prescribed drugs (such as Augmentin antibiotics, statins for lowering cholesterol or the ulcer drug Losec), a Clalit patient may pay up to about 3.5 times more than a Meuhedet member for the same drug. All but one of the 40 drugs were included in the basket of health services, he said. Sax said his findings were also relevant to patients in the Maccabi Health Services, which had an almost identical method of co-payment and level of charges as Meuhedet. Leumit patients normally paid slightly less than those of Meuhedet, he said. Due to the availability of cheaper generic versions of commonly prescribed drugs and deals with drug companies for lower prices, Meuhedet has reduced co-payment charges for a sample of leading medications from NIS 238 to NIS 128 over a period of time. Over the same period, Clalit reduced co-payments for these same drugs by only NIS 6, from NIS 233 to NIS 227. The study also showed that in spite of the availability of cheaper generic versions, Clalit often failed to pass on to its members the benefits of its substantially reduced acquisition prices. Sax urged the Health Ministry to establish a mechanism for monitoring the co-payment policies of the health funds, especially that of Clalit, as "co-payments for prescription drugs are an increasing financial burden for the growing vulnerable sectors of the population - the weaker socioeconomic groups, the aged and the chronically ill." Sax said approximately a quarter of these people said they couldn't afford to buy medications they needed. A disproportionate part of these groups are members of Clalit, 13% of whose members are over 65 years of age compared to only 6% in Maccabi, he said. Sax said the 40 most frequently prescribed drugs represented about half the total volume of prescriptions and prescription payments. Comparisons were made between payments made by patients in Clalit with those for the same drugs made by Meuhedet patients. A Clalit spokeswoman said Clalit's co-payment program was "set and approved by the Knesset Finance Committee in August 1998." She said members paid NIS 11 per portion for drugs on the original list, and 10% of the cost for drugs added to the basket after that or NIS 11 (the higher price between them). In addition, the Clalit spokeswoman said, Clalit members who participated in its supplementary health insurance plans (70% of the total) could get "significant discounts of 50% to 70% when they purchase medications."