Anthem's Mail-Order Meds Policy Puts HIV-Positive People at Risk
Posted 1/30/2013 2:00:00 PM

Anyone who has been living with HIV for any length of time can tell you the value and importance of their local, community pharmacist. We rely on them to remind us when it is time to refill our prescriptions, for advice regarding potentially harmful drug interactions and to connect us with other community resources to help support our quality of life.

For many, the community pharmacist is more than just another health care provider, he or she is an invaluable resource, an individual who is personally invested in our health and wellbeing, and a friend.

So it should come as no surprise that many people were shocked and dismayed late last year when they began receiving letters from Anthem, the largest private insurance company in California, informing their policyholders requiring “specialty” medications—including HIV medications—that they would have to terminate their relationships with their community pharmacists, and instead would be forced to obtain their lifesaving drugs from CuraScript, a mail-order pharmacy based out of Florida.

The letters—similar to the one reprinted here—brusquely informed policyholders that they have until the 1st of March to sign up with CuraScript or they will have to start paying full price for their medications.

“If you stay with your retail pharmacy, the medicine won’t be covered and it’ll cost you more money.”

Either sign up or you are on your own.

Anthem, of course, claims that this new policy is a cost-saving measure. That by forcing all of it’s HIV-positive policyholders to go through the same source for their medicine it “allows our contracted specialty pharmacy to secure bulk discounts for high cost drugs that help keep the benefit more affordable.”

But many low and middle-income individuals living with HIV rely on payment assistance programs developed between local pharmacies and the big pharmaceutical companies to help offset the high cost of co-pays and deductibles set by their insurance provider. Loss of access to these programs could cost many Californians already struggling through the state’s poor economic climate hundreds or even thousands of dollars a year.

And it isn’t hard to see how the potential short-term savings could easily be washed away by the probable long-term implications of this policy: The medication mix-ups and drug combination complications that are sure to happen when you force patients out of the care of their local pharmacist and instead leave them at the mercy of harried warehouse workers and poorly trained hotline operators.

The possibility that one’s medication could be lost or stolen as it makes its way across the country, through the postal system, is practically an assurance.

And in addition to potential consequences to the health of Anthem’s policyholders, there are also serious privacy concerns. Since CuraScript will only deliver to homes or offices, never to post office boxes, there is the very worrying possibility that some people could have their HIV-status broadcast to their neighbors or co-workers by a package left unattended on a desk or doorstep.

Those who have complied with their insurer’s demands to abandon the care of their community pharmacist for CuraScript’s uncertain mercies are already peppering the internet with horror stories. Oriol Gutierrez, the editor-in-chief over at POZ, recently wrote about a mysteriously canceled order that will leave him without access to his medications for almost a week. While ACT UP founder Larry Kramer writes about his frustrations in navigating CuraScript’s labyrinth of robo calls and incompetent, unhelpful personnel.

Fortunately, they might not have to suffer these indignities for long, as the consumer advocacy group, Consumer Watchdog, has filed a class-action lawsuit against Anthem, claiming their policy forcing HIV-positive individuals to get their medication through mail-order violates California’s anti-discrimination law.

The law in question, the 1959 “Unruh Civil Rights Act,” specifically outlaws discrimination based on “sex, race, color, religion, ancestry, national origin, disability, medical condition, genetic information, marital status or sexual orientation.” So it seems pretty clear that Anthem is breaking the law.

Let’s hope the courts agree. If they don’t, it’s going to put the health of thousands of people living with HIV at risk, and likely put many community pharmacists out of business.


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Posted By: Positive Frontiers  

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