A Violation of the Affordable Care Act
Memphis, TN -- Blue Cross Blue Shield of Tennessee is attempting to circumvent the central reform of the Affordable Care Act—the so called “guaranteed issue” provision, which ensures all patients are guaranteed access to health insurance regardless of their health condition—by discouraging patients with HIV/AIDS from enrolling in or remaining enrolled in its health plans, according to a new class action lawsuit.
Blue Cross Blue Shield of Tennessee patients with HIV or AIDS must obtain their medications from a “specialty pharmacy” and potentially face dramatic cost increases and threats to their health and privacy. The specialty pharmacies either provide HIV medications by mail, or from a limited number of brick-and-mortar pharmacies such that patients must travel for up to 2 hours to obtain their medications, according to the lawsuit.
“What’s the good of an insurance policy if an insurer is allowed to create roadblocks to the very medications you need to stay alive?” said Consumer Watchdog Litigation Director Jerry Flanagan. “HIV patients are forced to choose between either foregoing essential counseling from an expert pharmacist at a community pharmacy who is best positioned to detect potentially life-threatening adverse drug interactions and dangerous side effects, or pay thousands of dollars out-of-pocket for their HIV medications.”
Download the lawsuit that was filed in the U.S. District Court located in the Western Division of Tennessee here.
“Blue Cross provides either no or limited coverage for HIV medications costing thousands of dollars each month if patients do not obtain those medications from a specialty pharmacy. For all but the wealthiest HIV patients, such dramatic cost increases are untenable,” said Jerry Martin of Barrett Johnston & Garrison, LLC. “Even short interruptions in access to HIV/AIDS Medications can have a profound negative impact on a patient’s health.”
Whatley Kallas, LLP and Consumer Watchdog have settled six similar lawsuits against major health insurers. Under those settlements, HIV/AIDS patients have a right to obtain their HIV medications from a community pharmacy of their choice.
“Blue Cross patients should have a choice about how they obtain these life-saving medications and from whom, just as other companies have agreed,” said Edith Kallas of Whatley Kallas LLP.
Blue Cross Blue Shield of Tennessee’s treatment of HIV/AIDS patients is discriminatory under the Affordable Care Act, Americans with Disabilities Act, and other federal and state law:
• Due to the complex nature of HIV/AIDS drug regimens, patients rely on their community pharmacists who, working directly with patients, monitor potentially life-threatening adverse drug interactions and side effects.
• Mail-order delivery of these medications, often requiring large refrigerated containers, is not a viable option for many patients and can raise major privacy implications, particularly for those individuals who have not revealed their medical condition to employers, co-workers, friends, and family members due to the social stigma that continues to be associated with the disease.
• Because there is no cure for HIV/AIDS, the virus continually mutates around the medications prescribed to treat it, requiring constant monitoring and immediate provision of new medication regimens to address changes in the disease that can only be provided by community pharmacists.
• Community pharmacists, who often have greater contact with HIV/AIDS patients than physicians and know their complete drug regimen, provide essential advice and counseling that help HIV/AIDS patients and families navigate the challenges of living with a chronic and often debilitating condition.
• Blue Cross Blue Shield of Tennessee’s specialty pharmacy program replaces these life-saving interactions with an 800 number that places the burden of securing life-sustaining medications on chronically ill patients.
• HIV/AIDS patients must call-in each month to renew their prescriptions—and work their way through automated robocalls, messages and multiple call center staff—increasing stress and fatigue for patients who are literally fighting to stay alive, exacerbating their condition.
• The use of mail-order providers also creates the very real risk of delayed, lost or stolen shipments, resulting in dire consequences for many patients who must strictly adhere to their medication regimes or face serious illness or death.
• If HIV/AIDS patients do not obtain their medications from a specialty pharmacy, they must pay full-price for their medications—easily thousands of dollars or more each month—to purchase their medications at their community pharmacy.
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Consumer Watchdog is a nonpartisan consumer advocacy organization with offices in Washington, D.C. and Santa Monica, CA. For more information, go to: 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/
Barrett Johnston & Garrison, LLC, based in Nashville, Tennessee, represents people of all walks of life who have challenging, complex and complicated legal problems. The success the firm has had on behalf of its clients is tied directly to the deep personal satisfaction the lawyers at Barrett Johnston & Garrison, LLC get from taking on challenging cases on behalf of worthy causes. Simply put, we like what we do, and we often achieve incredible results. For more information, go to: https://barrettjohnston.com/