A consumer organization and an anonymous HIV/AIDS patient are suing Aetna in federal court, claiming the insurer discriminates against people with HIV/AIDS by requiring them to buy medications through the mail starting Jan. 1.
The plaintiffs say the mail order requirement is expensive and violates patients' privacy.
The patient and advocacy group, Consumer Watchdog, filed the lawsuit Friday in U.S. District Court for the Southern District of California. The group alleges Aetna is circumventing a provision in the Affordable Care Act — so-called guaranteed issue — which allows everyone access to medical coverage regardless of his or her medical condition.
The lawsuit alleges Aetna requires patients to obtain specialty medications for HIV/AIDS treatment and other serious illnesses from ASP, an Aetna subsidiary. ASP only delivers medications by mail, which threatens patients' health and privacy, attorneys for the plaintiffs argue.
Aetna spokeswoman Cynthia Michener said ASP is not the only option in Aetna's pharmacy network, and that some in-network options are not mail-order.
Mail-order delivery of HIV/AIDS medications isn't viable because the drugs require large refrigerated containers, Consumer Watchdog said. Additionally, the mailing of those drugs raises privacy concerns for patients who haven't shared their medical condition with employers, co-workers, friends or family members, the consumer group said.
"If HIV/AIDS patients do not obtain their specialty medications from ASP, they must pay thousands of dollars or more each month to purchase their medications at their community pharmacy," attorneys wrote in the lawsuit.
Drug treatments for HIV/AIDS patients require patients to meet with a pharmacist regularly because the virus mutates, adapting to medications that are used to treat the disease, the consumer group said. Aetna has replaced regular pharmacy meetings with an 800-number for chronically ill patients, the consumer group said.
Consumer Watchdog said it has also sued UnitedHealthcare and an Anthem Blue Cross in another state over similar mail-order policies.
In an email, Michener, at Aetna, said, "As part of our ongoing strategy to do all we can to keep our health plans affordable and help with medication adherence, Aetna moved HIV medications to our specialty drug list.
"This list includes a number of high-cost medications that treat complex conditions that require close patient monitoring," Michener wrote. "This move is consistent with industry standards. We also ask that members use Aetna Specialty Pharmacy, but members may opt out and use any pharmacy."
Attorneys are asking the judge for class status, meaning patients affected by Aetna's policy would be in a class-action lawsuit against the insurer.
"HIV patients will be forced to choose between either foregoing essential counseling from an expert pharmacist at a community pharmacy who is best positioned to detect potentially life-threatening adverse drug interactions and dangerous side effects, or pay thousands of dollars out-of-pocket for their medications at their community pharmacy," Consumer Watchdog Lead Staff Attorney Jerry Flanagan said in a statement.
John Doe, the anonymous lead plaintiff in the case, said in a statement: "Playing just-in-time inventory games with an HIV medication that requires nearly 100 percent compliance to remain effective to keep the virus under control is a short-sighted business practice and a danger to my health."
