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Consumer Watchdog Files Suit Over Anthem's Rx Program

CALIFORNIA HEALTHLINE

Consumer Watchdog has filed a class-action lawsuit against Anthem Blue Cross, alleging that the insurer's mail-order pharmacy program discriminates against individuals with HIV/AIDS, KQED's "State of Health" reports.

About Anthem's Program
Anthem has changed its prescription drug program so that anyone seeking medication from a list of "specialty" drugs are required to use a mail-order pharmacy approved by the insurer. However, patients seeking to fill other types of prescriptions still will be able to use their regular retail pharmacy.

Details of Consumer Watchdog's Complaints
Jerry Flanagan, a Consumer Watchdog attorney, said that the change in policy represents "exactly the kind of targeting and discrimination barred under the Civil Rights Act in California."

According to Flanagan, many low- and middle-income individuals with HIV/AIDS depend on programs established between specialty pharmaceutical companies and retail pharmacies that help pay for deductibles and copayments. He said that one plaintiff in the case already has incurred hundreds of dollars in out-of-pocket costs because of the change in policy.

Anthem's Response
In a statement, Anthem said that the policy change is not discriminatory because the list of specialty medications includes drugs for various conditions and not just for HIV/AIDS.

It said, "Anthem's policies do not discriminate on the basis of disease states, and they are reasonable and compliant with applicable laws."

Anthem also said that the mail-order pharmacy it has selected offers a special program for HIV/AIDS patients. According to Anthem, findings show that patients who use the program have a 93% drug adherence rate, which is "nearly 10% higher than patients using a retail pharmacy."

Similar Policy Changes
Marta Green of the Department of Managed Health Care said that three other insurers in the state have adopted similar mail-order pharmacy programs, including:

  • Health Net;
  • Sharp; and
  • United Health Care of California.

Green declined to comment on the Consumer Watchdog lawsuit (Aliferis, "State of Health," KQED, 1/15).