The California advocacy group Consumer Watchdog has sued UnitedHealthcare, the nation’s largest insurer, alleging it is illegally forcing its sickest and most vulnerable members to abandon their local pharmacies in favor of United’s own in-house mail-order service.
The mail-order rule is discriminatory under state civil rights law and threatens the health and safety of HIV/AIDS patients, the lawsuit alleges. Due to the sensitive nature of the action, the lead plaintiff in the lawsuit is listed as “John Doe.”
UnitedHealthcare said in a statement its legal team was reviewing the complaint, but the health plan ensures members have access to needed prescriptions. Some younger people prefer mail-order prescriptions due to the same privacy concerns cited in the lawsuit, a spokesman said.
The lawsuit seeks statewide class certification, a court order to stop implementation of the mail-order rule, damages and attorneys’ fees.
“Patients, not insurers, should be allowed to decide how, when and where they buy their medications,” Consumer Watchdog staff attorney Jerry Flanagan said in a news release.
Court documents allege members are being told they must buy “specialty medications” to treat HIV/AIDS and other serious illnesses through United’s mail-order pharmacy, while non-specialty drugs will continue to be available at retail pharmacies. Members who balk and try to buy specialty meds at retail pharmacies will be on the hook for “thousands of dollars or more each month.”
The policy is discriminatory and threatens the privacy of HIV/AIDS patients who have to forego counseling from a local pharmacist who knows their medical history, court documents state.
The lawsuit follows settlement last month of a similar action against Anthem Blue Cross that allows patients with HIV/AIDS to opt out of the company’s mail-order pharmacy program.
Kathy Robertson covers health care, law and lobbying, labor, workplace issues and immigration for the Sacramento Business Journal.