Santa Monica, CA — Patients with HIV and AIDS enrolled in health coverage provided by United Healthcare, the nation’s largest health insurer, may now “opt-out” of a requirement that they obtain their medications by mail-order if they have privacy or delivery concerns, or if they have difficulty discussing their HIV medications over the phone. The settlement providing the “opt-out” right resulted from a national class action lawsuit brought by Consumer Watchdog and Whatley Kallas, LLP.
The lawsuit, filed in June of 2013 in federal court in Orange County and presided over by United States District Court Judge David O. Carter, alleged that United’s mandatory mail-order requirement illegally targeted HIV/AIDS patients. The Court approved the settlement on July 31, 2014. As of September 4, patients may now exercise their opt-out right.
HIV/AIDS patients expressed serious concerns about a loss of privacy associated with mail order. For example, HIV/AIDS specialty medications often are delivered in refrigerated containers. Patients who live in apartment buildings or have medications delivered to their work place have expressed alarm that neighbors, co-workers, and employers, who do not know that the recipient has HIV/AIDS, would come to suspect that they are seriously ill. Others expressed concern that delayed or stolen mail-order packages would result in serious threats to their health.
Due to the complex nature of HIV/AIDS drug regimens, patients often rely on their community pharmacists who, working directly with patients, monitor potentially life-threatening adverse drug interactions and side effects. Pharmacists also provide essential advice and counseling that help HIV/AIDS patients and families navigate the challenges of living with a chronic and often debilitating condition.
Opt-Out Process
If patients do not want to obtain their HIV/AIDS specialty medications by mail based on privacy or delivery concerns, or if they have difficulty discussing their HIV medications over the phone, they may obtain a permanent exemption from mail-order delivery and obtain their medication from an in-network community pharmacy.
To opt-out of the mail-order requirement, patients may either download and submit the form available at http://tinyurl.com/puf2epr or call 1-866-803-8570. If they call, patients are asked to have their membership number and the name and address of the in-network pharmacy they want to designate to obtain their HIV/AIDS medications.
“This settlement brings to a close a nerve-racking episode for patients with HIV and AIDS who faced serious threats to their privacy and health,” said Jerry Flanagan, lead staff attorney for Consumer Watchdog.
The list of drugs for which a patient suffering from HIV/AIDS may opt-out of the mail order requirement includes anemia, growth hormone, and neutropenia drugs in addition to drugs used to treat HIV/AIDS. Class members who paid more for their prescriptions as result of the mail-order requirement may also seek reimbursement of their out-of-pocket costs.
“United should be commended for listening to the serious and heartfelt concerns of their customers who depend on local pharmacists for their life-saving medications,” said Edith Kallas of Whatley Kallas, LLP. “The settlement with United creates a new national precedent for protecting vulnerable patients subject to mandatory prescription drug mail-order programs.”
Download the settlement agreement here: http://www.consumerwatchdog.org/resources/settlementagreement3-19-14.pdf
Read more about the settlement here: http://www.unitedhivsettlement.com
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Consumer Watchdog is a nonpartisan consumer advocacy organization with offices in Washington, D.C. and Santa Monica, CA. Find us on the web at: http://www.ConsumerWatchdog.org
The lawyers of Whatley Kallas, LLP have been repeatedly recognized in legal publications, such as The National Law Journal and American Lawyer, by their peers and by leaders of organized medicine for their work in the healthcare field. For more information, go to: http://www.whatleykallas.com/
