Anthem Delays Mail-Order Rx Rule In Face Of Bias Suit

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In response to a proposed class action alleging discrimination and privacy violations, California health insurer Anthem Blue Cross has backed away from a requirement that patients with certain chronic diseases obtain drugs through a mail-order pharmacy, a consumer rights group said Tuesday.

Consumer Watchdog, which filed an anti-discrimination lawsuit last month on behalf of an unidentified HIV-positive man, released a letter Anthem sent Friday to policyholders announcing it won’t transition March 1 to a mail-order program for certain specialty medicines.

In the correspondence, Anthem suggested customers were unhappy with the shift to specialty pharmacy CuraScript Inc., a division of Express Scripts Co., and that it’s retooling its approach as a result.

“Because Anthem has received feedback about this specialty pharmacy program from its members, we are evaluating that input to better serve our members and, for the time being, have eliminated the [March 1] required date to use CuraScript for such additional specialty medications,” the company wrote.

While not ruling out a future mail-order mandate, Anthem vowed in the letter to “clearly communicate all aspects of the specialty pharmacy program to you before any changes to the existing program are put in place.”

Darrel Ng, spokesman for Anthem, confirmed the delay and said no decision has been reached on the ultimate shape of the policy.

In a statement, Consumer Watchdog said the insurer’s move is intended to allow the parties time to craft a “more consumer-friendly program.”

“[Anthem] 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 LLC, co-counsel for the San Diego lead plaintiff.

"We look forward to working with Blue Cross to ensure its mail-order program benefits consumers without unfairly targeting its most vulnerable patients and [by] providing them appropriate opportunities to choose what is best for them,” Kallas said.

The complaint alleged that Anthem ran afoul of the Unruh Civil Rights Act by proposing to require individual plan members to purchase specialty medicines by mail, unless they obtained a hardship waiver every six months allowing them to patronize brick-and-mortar pharmacies. The Unruh Act is a California law prohibiting discrimination based on a number of factors, including medical condition.

If a patient wished to continue using a traditional pharmacy for specialty medicines, the plan would have treated it as an out-of-network venue and held the patient liable for the full price of drugs that can cost thousands of dollars each month, the lawsuit said. In addition, under the policy, patients would have faced bigger bills because certain discounts and copay waivers they currently enjoy wouldn't have been available through the mail-order service, the complaint asserted.

Service would also have suffered, as patients would have to cut ties with pharmacists who understood their situations and could be on the lookout for dangerous drug interactions, the lawsuit contended.

Further, getting medicines by mail is a particularly bad idea for HIV/AIDS patients, because a delayed or stolen shipment could seriously jeopardize care, the lawsuit argued. By being forced to receive regular deliveries of pharmaceuticals at their homes or workplaces, HIV/AIDS patients would also lose their “fundamental and inalienable right to privacy,” the complaint said.

Last month, Ng said research has found that patients using CuraScript have a 93 percent adherence rate to their drug regimens, nearly 10 percent higher than those using traditional drugstores.

In addition, all HIV/AIDS patients receive 24-hour access via CuraScript to social workers, community support resources, nursing assistance and pharmacists, he said. As for privacy considerations, deliveries can be made to a variety of locations, including a doctor’s office, Ng said.

The plaintiff is represented by Harvey Rosenfield, Pamela Pressley and Jerry Flanagan of Consumer Watchdog and Edith M. Kallas, Alan M. Mansfield and Kristin Libby of Whatley Kallas LLC.

Counsel information for Anthem was not immediately available.

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