Santa Monica, CA — Aetna 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 Aetna health plans, according to a new national class action lawsuit filed by Whatley Kallas, LLP and Consumer Watchdog.
Under changes currently set to begin January 1, HIV/AIDS patients must now obtain their medications by mail and potentially face dramatic cost increases and threats to their health and privacy.
“What’s the good of an insurance policy if you can’t timely get the medications you need to stay alive?” said Consumer Watchdog Lead Staff Attorney Jerry Flanagan. “HIV patients will be 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 medications at their community pharmacy.”
Download the lawsuit, which was filed in a California federal Court in San Diego here: http://www.consumerwatchdog.org/resources/Dkt1Complaint121914.pdf
“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.
Whatley Kallas, LLP and Consumer Watchdog have settled two similar suits against United Healthcare and Anthem Blue Cross. Under those settlements, HIV/AIDS patients have a right to opt-out of the mail-order program.
Aetna’s treatment of HIV/AIDS patients is discriminatory under the Affordable Care Act, Americans with Disabilities Act, and civil rights 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.
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.
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.
Aenta’s mail-order pharmacy 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 specialty medications by mail, they must pay full-price for their medications—easily thousands of dollars or more each month—to purchase their medications at their community pharmacy.
Even if HIV/AIDS patients obtain their medications by mail-order they face discriminatory pricing in the form of a new 20% coinsurance charge of up to a $150 per prescription.
“Playing just-in-time inventory games with an HIV medication that requires nearly 100% compliance to remain effective to keep the virus under control is a short sighted business practice and a danger to my health,” says John Doe, the lead plaintiff in the lawsuit who filed the complaint anonymously.
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Consumer Watchdog is a nonpartisan consumer advocacy organization with offices in Washington, D.C. and Santa Monica, CA.
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/
