HIV Patient Says Anthem Mail-Order Drug Plan Discriminatory

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An HIV-positive man Friday hit California health insurer Anthem Blue Cross with a proposed consumer class action alleging the company’s plan to force patients with certain chronic diseases to obtain medications through a mail-order pharmacy is a discriminatory move that will drive up costs and threaten lives.

The complaint from an unidentified San Diego resident said Anthem is flouting the state’s Unruh Civil Rights Act by requiring individual plan members purchase “specialty medicines” by mail unless they obtain a hardship waiver every six months allowing them to patronize a brick-and-mortar pharmacy.

If a patient wishes to continue using a traditional pharmacy for such medicines, they’ll be treated as visiting an out-of-network venue and held liable for the full price of drugs that can cost thousands of dollars each month, the lawsuit said. In addition, under the policy taking effect March 1, patients will face bigger bills because certain discounts and co-pay waivers they currently enjoy aren’t available through the mail-order service, the complaint asserted.

Service will also suffer as patients have to cut ties with pharmacists who understand their plights and can be on the lookout for dangerous drug interactions, the lawsuit contended.

“Anthem Blue Cross proposes to replace the present, ongoing, close relationship between pharmacist and patient with an 800 number,” the lawsuit said.

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

“Neighbors and co-workers, who do not know that the recipient has HIV/AIDS, would quickly realize the recipient is suffering from a serious ailment,” according to the complaint.

Darrel Ng, a spokesman for Anthem, told Law360 on Monday that research has found that patients using the insurer’s mail-order pharmacy, 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, Ng said. As for privacy considerations, deliveries can be made to a variety of locations, including a doctor’s office, Ng said.

“This is being done with the knowledge of our regulator and applies to several hundred different drugs for many medical ailments,” Ng said. “Anthem's policies do not discriminate on the basis of disease states, and they are reasonable and compliant with applicable laws.”

The complaint asserts Anthem recently said it was switching to home delivery as part of a contract to buy drugs in bulk and cut costs, and that the new policy covers more than two dozen conditions, including HIV/AIDS, cancer, hemophilia, multiple sclerosis and osteoporosis.  

Lynda Gledhill, a spokeswoman for California Attorney General Kamala Harris, declined Monday to say whether the state was investigating the matter but suggested the policy change hasn’t gone unnoticed.

”We take very seriously cases that involve restricting access to health care,” Gledhill told Law360.

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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