San Diego, CA: An insurance lawsuit has been filed against Blue Cross of California, alleging a new program run by the company amounts to discrimination. In addition to claims of discrimination, the lawsuit alleges Blue Cross is guilty of bad faith insurance, not because policyholders have had their insurance claim denied, but because the new program allegedly discriminates against patients with HIV/AIDS.
The lawsuit was filed by Consumer Watchdog on January 11, on behalf of California residents with HIV/AIDS. According to the lawsuit, policyholders with HIV/AIDS or other serious conditions, are no longer permitted to obtain their prescriptions through store pharmacies. Rather, they must purchase their medications through a mail-order pharmacy called CuraScipt, which is owned by Express Scripts Inc, according to the lawsuit. To be permitted to get their prescription from store pharmacies, the policyholders must obtain a waiver from Blue Cross every six months. If the patients purchase medication from a retail pharmacy, they will be considered to have gone "out-of-network," meaning the patient would be responsible for paying the full price of the medication, in some cases, thousands of dollars.
"As a result, not only will [the patients'] level of service be materially reduced, they will also have their individual costs increased, even if they use the mail order requirement, by not being able to receive the benefits of discounts and co-pay waivers that they presently receive but that are not available through the mail-order service," the plaintiffs allege in court documents (found online at http://www.consumerwatchdog.org.).
Plaintiffs argue that by purchasing their medications through a mail-order pharmacy they will no longer have the benefit of a clinical pharmacist monitoring them for potentially dangerous drug interactions. Furthermore, they run the risk of problems with shipments??"including delays or lost shipments??"which could have serious health risks for the patient. Ultimately, the new policy allegedly reduces the quality and continuity of care patients receive because of the lack of face-to-face interaction with a pharmacist.
Included in the lawsuit are allegations the policy violates the Unruh Civil Rights Act, which makes discrimination, including that based on medical conditions, illegal. According to court documents, the policy change was to go into effect January 1, 2013, but has been delayed until March 1, 2013. The plaintiffs allege Blue Cross started the program to further increase profits, at the expense of the needs of policyholders.
The lawsuit, which was filed on behalf of residents of California who are enrolled in a Blue Cross individual plan and have been prescribed HIV/AIDS-related maintenance medication drugs, is Doe v. Blue Cross of California, d/b/a Anthem Blue Cross, in San Diego Superior Court. The case number is currently not available.