Aetna, Inc., and its subsidiary Coventry Health Care Inc., are attempting to circumvent the central reform of the Affordable Care Act—the so called “guaranteed issue” provision, which ensures all patients are guaranteed access to health insurance regardless of their health condition—by discouraging patients with HIV/AIDS from enrolling in or remaining enrolled in Aetna and Coventry health plans, according to two national class action lawsuits currently being litigated by Whatley Kallas, LLP and Consumer Watchdog.
Following the filing of the class action lawsuit against Aetna, Aetna claims to have terminated the mail-order program for its Aetna-branded health plans.
However, patients enrolled in Coventry health plans continue to receive notices stating they must obtain their medications by mail and face threats to their health and privacy.
“What’s the good of an insurance policy if you can’t timely get the medications you need to stay alive?” said Consumer Watchdog Litigation Director Jerry Flanagan. “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.”
Download the lawsuit agasint Aetna, Inc., which was filed in a California federal Court in San Diego here.
Download the lawsuit against Coventry Health Care Inc., which was filed in a Florida federal Court here.
Read Consumer Watchdog's and Whatley Kallas' recent brief regarding violations of the Affordable Care Act and other federal law here.
“Patients should have a choice about how they obtain these life-saving medications and from whom, just as other companies have agreed,” said Edith Kallas of Whatley Kallas LLP.
Whatley Kallas, LLP and Consumer Watchdog have settled four similar suits against Anthem Inc., United Healthcare, Cigna and Anthem Blue Cross of California. Under those settlements, HIV/AIDS patients have a right to opt-out of the mail-order program.
Aetna’s and Coventry's treatment of HIV/AIDS patients is discriminatory under the Affordable Care Act, Americans with Disabilities Act, and civil rights law:
- Due to the complex nature of HIV/AIDS drug regimens, patients rely on their community pharmacists who, working directly with patients, monitor potentially life-threatening adverse drug interactions and side effects.
- Mail-order delivery of HIV/AIDS medications is not a viable option for many patients and can raise major privacy implications, particularly for those individuals who have not revealed their medical condition to employers, co-workers, friends, and family members.
- Because there is no cure for HIV/AIDS, the virus continually mutates around the medications prescribed to treat it, requiring constant monitoring and immediate provision of new medication regimens to address changes in the disease.
- Community pharmacists, who often have greater contact with HIV/AIDS patients than physicians and know their complete drug regimen provide essential advice and counseling that help HIV/AIDS patients and families navigate the challenges of living with a chronic and often debilitating condition.
- Mail-order pharmacies replace these life-saving interactions with an 800 number that places the burden of securing life-sustaining medications on chronically ill patients.
- HIV/AIDS patients must call-in each month to renew their prescriptions—and work their way through automated robocalls, messages and multiple call center staff—increasing stress and fatigue for patients who are literally fighting to stay alive, exacerbating their condition.
- The use of mail-order providers also creates the very real risk of delayed, lost or stolen shipments, resulting in dire consequences for many patients who must strictly adhere to their medication regimes or face serious illness or death.
- If HIV/AIDS patients do not obtain their specialty medications by mail, they must pay full-price for their medications—easily thousands of dollars or more each month—to purchase their medications at their community pharmacy.
“Playing just-in-time inventory games with an HIV medication that requires nearly 100% compliance to remain effective to keep the virus under control is a short sighted business practice and a danger to my health,” says John Doe, the lead plaintiff in the Aetna, Inc. lawsuit who filed the complaint anonymously.