Anthem Caves
Posted 2/15/2013 2:52:00 PM

Editor's Note: Today's article comes to us from guest columnist Thomas DeLorenzo, following up on a story reported last month in Positive Frontiers.

Apparently having HIV/AIDS isn’t a big enough problem on its own, you also get to have all sorts of ignorant people get in the way of your health care, simply because they want to make a buck, or because they are scared. Last fall, Anthem Blue Cross, working with its business partner and owner of its pharmacy benefits management, Express Scripts, announced that as of Jan. 1, 2013, all HIV/AIDS-related medication were going to be covered only if you went through Express Scripts mail order service. Anthem allowed that one could still go to the local pharmacy, but only if they were willing to pay full price for their medication. There was a great deal of outrage from Anthem's policyholders and the date was pushed back to March 1st.

Talk about a corporate slap in the face. One of the most crucial relationships a person with HIV/AIDS can have is the one they have with their pharmacist. It’s the one healthcare provider you are going to see regularly, several times a month probably, who can see how your health really is, and notice any problems before they become nightmares.

I am grateful for my pharmacist. I go to West Knoll Pharmacy in West Hollywood and I could not imagine having UPS replace them. They explain, they question, they notice and they care. I am not a number to them—I am a person. And, more importantly, they are on my side, fighting with me in the trenches to make sure this virus does not do any more to me than it already has. 

Even though I am not an Anthem client, I am not out of the reach of Express Scripts' wrath. My provider, Cigna, sold their pharmacy benefits management to Express Scripts a few years ago. So far, they have only made one of my partner’s drugs mandatory mail order. And, yes, they have made several mistakes with that order since that policy’s existence. 

When my partner put me on his insurance policy, I kept my previous policy, just to make sure all would be fine. I wanted to test drive his coverage before I gave up mine. I had an individual policy with Blue Shield of California and they were pretty great to me—it was just costing me a fortune. The opportunity to get involved with a group policy, such as my partner’s, was a dream come true. My monthly bill would go down, and I would have even better access to care!

That dream came to an end pretty fast when they refused to cover my Testim, something that I take to literally help me get out of bed and keep going all day. The woman on the phone asked me if I would mind taking a blood test to show them low testosterone. I replied, “Sure, that would be no problem, but while we are at it, how about I stop taking all of my medications so you can see that my currently undetectable virus is indeed there, so you know I really need to take the HIV meds.”

The woman on the phone paused, and said, “May I put you on hold for a moment?”

When she returned, she simply said, “Mr. DeLorenzo, your Testim has been approved. No need for any blood test.”

According to the Courage Campaign, Anthem Blue Cross announced earlier today that it would put on indefinite hold it's plans to move all HIV/AIDS, and other specialty drugs, to mandatory mail order service. This move was made only after several lawsuits were filed, dozens of consumer groups gathered their troops and dozens more media outlets gave Anthem Blue Cross pages and pages of negative press. 

Consumer Watchdog of Santa Monica, working with the law firm Whatley Kallas LLC, filed a lawsuit in the Superior Court of California in San Diego County on behalf of a John Doe plaintiff in San Diego. The lawsuit was based on privacy issues, patient care and civil rights. The complaint against Anthem described how people with HIV/AIDS were being singled out and were offered substandard care just because they were the different. In California, that is a clear violation of the Unruh Civil Rights Act of 1958. That act prohibits discrimination based on disability and/or sexual orientation, amongst other things.

This time, we all collectively picked up the phone and put the pressure on Express Scripts. This time it worked. However, the answer is not final, it is only for an “indefinite” term until final agreement can be worked out. How long is “indefinite” and what will this new agreement actually consist of? 

That’s what worries me. What we need is legislation making it illegal to create a mandatory program for pharmacy benefits, just like they did in New York state. In January of 2012, it became against the law to limit the consumer’s choices and create a mandatory mail order drug system. California needs something like this—a law which clearly keeps the choice with the consumer—and we need it now. 

Today we won. And just like any other problem with HIV, you just take it a day at a time. However, we need to start talking with our legislators and get them to enact a bill so we never have to fight this fight again.

Currently a 2L law student at Southwestern Law School and former entertainment publicist, Thomas DeLorenzo is the first long-term survivor with AIDS to attend law school. DeLorenzo also writes for the 
Huffington Post and DeLorenzo had the honor of working with Whatley Kallas LLC on this case, and also is an academic intern for the multinational law firm of Holland & Knight. In 2006, the
New York Times named DeLorenzo the “Unsung Hero of the Year” for HIV/AIDS. DeLorenzo has also been honored by Nassau County Board of Supervisors, Hofstra University, University of Richmond and UCLA. DeLorenzo is studying health policy law in order to continue doing exactly what he is doing now—keeping the “care” in health care.

Editor's Note: In it's original iteration this piece neglected to cite the Courage Campaign. Some aditional minor changes have been made for the sake of clarity.

Posted By: Positive Frontiers  

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