LOS ANGELES (CN) – United Healthcare Insurance subjects thousands of HIV-positive Californians to "potentially life-threatening" delays by making them get their prescription drugs through the mail, a class action claims in Federal Court.
John Doe sued United Healthcare Insurance, mail order pharmacy OptumRx, Pacificare Life and Health Insurance, and UnitedHealth Group on five counts, including unfair competition, breach of faith and violation of the Unruh Civil Rights Act.
The insurer requires that HIV/AIDS patients buy OptumRx-supplied "'specialty medications'" by mail order, according to the complaint. Doe claims that patients' only alternative is to spend thousands of dollars on retail pharmacy medications not covered by their insurance plans.
"For all but the wealthiest HIV/AIDS patients, such dramatic cost increases are untenable and thus many class members are left with no choice at all," the complaint states.
Doe claims the program violates the "fundamental and inalienable right to privacy" of thousands of patients.
"HIV/AIDS specialty medications often are delivered in refrigerated containers," the complaint states. "Class members who live in apartment buildings or have medications delivered to their work place have expressed alarm that neighbors and co-workers, who do not know that the recipient has HIV/AIDS, would come to suspect that they are seriously ill. Mail-order shipment also presents the risk of lost or stolen medications. Alternatively, requiring the recipient to be present when the package is delivered forces the patient to obtain needed medications on the schedule of the delivery person as compared to their own, and raises further privacy concerns."
The mail order program deprives patients of "essential counseling" from clinical pharmacists who know their patients' medical histories, and can discuss the side effects and risks of taking certain medications, the class claims.
In contrast, "OptumRx will not have a full and accurate record of all the medications the patient is prescribed and therefore cannot anticipate or warn against potential adverse drug interactions," Doe claims in the complaint.
HIV/AIDS requires "constant monitoring" because "the virus continually mutates around the medications prescribed to treat it," Doe says. So patients must stop their old drug regimen before taking new medications.
OptumRx has "incorrectly dispensed both the new medication and the old medication" or the "incorrect dosage," the class claims.
"Mail order providers such as OptumRx also run the very real risk of delayed, lost or stolen shipments, resulting in dire consequences for many patients who must adhere to strict medication regimes or face serious illness or death. Yet, defendants appear to have no fail-safe procedure in place to allow consumers to purchase medications at retail pharmacies in the event that mail-order shipments are delayed, lost, or stolen," according to the complaint.
Patients must call a 1-800 number each month to renew their prescriptions, increasing "stress and fatigue for patients who are literally fighting to stay alive," the class claims.
An OptumRx call center representative told one patient that he should try his luck at the emergency room, Doe says.
"'It is not my problem,'" the representative is alleged to have told the patient. "'(I)t is your responsibility to make sure you get your lifesaving drugs on time.'"
Doe claims that his interactions with OptumRx "confirmed his worst fears."
He calls OptumRx customer service "poor," and claims that on one occasion he received his medications with just a few days left on his previous prescription.
He claims that United Healthcare has "specifically targeted" HIV/AIDS patients, denying them "full and equal access" to retail pharmacies.
"When patients attempt to opt out of the program they are told they have no choice. But secretly, defendants have granted some enrollees who complain enough or threaten to take action the ability to not participate in the program. Plaintiff believes all similarly situated people should be given that same opportunity," the complaint states.
Doe seeks actual, compensatory, statutory and exemplary damages for unfair competition, common counts and assumpsit/common law restitution, breach of implied covenant of good faith and fair dealing, and violation of the Unruh Civil Rights Act, and an injunction.
He is represented by Harvey Rosenfield with Consumer Watchdog, of Santa Monica.