The nation’s largest health insurance carrier is facing a lawsuit alleging its mandatory in-house mail-order prescription service illegally threatens the health and privacy of patients who have HIV/AIDS and other serious illnesses.
Public advocacy group Consumer Watchdog sued United Healthcare Insurance Co., claiming the company is forcing patients to purchase their “specialty medications” from its subsidiary OptumRx Inc. or pay “thousands of dollars or more each month” at their local retail pharmacies.
Enrollees who buy prescription drugs that United does not consider specialty medications may continue to do so at retail pharmacies without penalty, according to the lawsuit in the U.S. District Court for the Central District of California.
“United’s decision to force their most vulnerable members into a pharmacy program not of their choosing is harmful to the very people United is supposed to be protecting,” Consumer Watchdog staff attorney Jerry Flanagan said in a statement. “Patients, not insurers, should be allowed to decide how, when and where they buy their medications.”
The new policy is discriminatory because it forces HIV/AIDS patients to forgo counseling from an expert pharmacist who knows their medical history and is “best positioned to detect potentially life-threatening adverse drug interactions and dangerous side effects,” according to the complaint.
Pharmacists at local retail pharmacies also provide “essential advice and counseling that help HIV/AIDS patients and families navigate the challenges of living with a chronic and often debilitating condition,” the complaint says.
“United’s mail-order pharmacy replaces these life-saving interactions with an 800 number that places the burden of securing life-sustaining medications on seriously ill patients,” the complaint says.
Patient privacy is also threatened under the new policy because HIV/AIDS specialty medications often are delivered in refrigerated containers, which may lead neighbors and co-workers to suspect that the patient is seriously ill, according to the complaint.
The lawsuit against United comes less than two weeks after Consumer Watchdog settled a similar suit against Anthem Blue Cross of California. Under the proposed settlement, Anthem agreed to give HIV/AIDS patients the unconditional right to opt out of its mail-order service at any time. Doe v. Blue Cross of Cal. et al., No. 37-2013-00031442-CU-CR-CTL, proposed settlement reached (Cal. Super. Ct., San Diego County May 15, 2013).
Consumer Watchdog seeks a court order barring United from continuing to implement its mandatory mail-order prescription service.
The complaint also seeks class-action status, restitution, disgorgement of profits, and compensatory and exemplary damages.
Doe v. United Healthcare Insurance Co. et al., No. 13-864, complaint filed (C.D. Cal., S. Div. June 7, 2013).