HIV Patients in Class-Action Lawsuit over Forced Mail-Order Drug Program

Friday, June 14, 2013

Four months after Anthem Blue Cross yielded to pressure and suspended its mandatory mail-order drug plan for HIV/AIDS patients, a class-action lawsuit (pdf) has been filed against United Healthcare for having the same requirement.

The suit, filed by Consumer Watchdog and Whatley Kallas LLP in U.S. District Court Central District of California, claims that “HIV/AIDS patients face a potentially life-threatening decision that also threatens their privacy” because of United Healthcare’s requirement that they use mail-order pharmacies.

Many of the drugs used by HIV/AIDS patients need refrigeration, but delivery to a house, apartment or office could be problematic for more than just safety reasons. Neighbors and co-workers who weren’t aware of a patient’s health situation would be alerted to the seriousness of their condition.

HIV/AIDS users also rely on personal contact with pharmacists for monitoring and adjustments in medication, and that would be replaced by an 800 number and no local backup source. “Mail order providers such as OptumRx also run the very real risk of delayed, lost or stolen shipments, resulting in dire consequences for many patients who must adhere to strict medication regimes or face serious illness or death,” the lawsuit argues.

The lawsuit mimics one filed by the same plaintiffs against Anthem Blue Cross in San Diego County Superior Court. Both lawsuits allege discrimination over a medical condition, barred by the Unruh Civil Rights Act since 1959. Anthem’s subsequent settlement allows HIV/AIDS patients to opt out of the mail-order program and continue using their local pharmacy.

Opting out of the United Healthcare network is not an option for anyone but the wealthiest patients. The cost of drugs is astronomical. John Doe, one of the anonymous patient plaintiffs in the case, pays just a $20 co-pay for each of his drugs as long as he remains in the network.

His monthly bill if he goes outside the network is $1,218.37. He could then apply for partial reimbursement that is not predetermined. The lawsuit says that John Doe’s drug regimen is considered relatively inexpensive compared to other HIV/AIDS regimens.    

John Doe has made an effort to use the remote OptumRx pharmacy with poor results. He phoned to set up his account and was told to call back when his prescriptions were confirmed by his doctor’s office. When he called back, he was told he would have to wait for OptumRx personnel to review his order. He called back and was told the “pharmacy specialist” was not available and he should call back the next day. He finally received his meds with a few days to spare.

John Doe is required to call in monthly to order his drugs.

–Ken Broder


To Learn More:

 HIV Patients Fight Mail-Order Drug Program (by Matt Reynolds, Courthouse News Service)

United Healthcare Sued for Discriminating Against HIV/AIDS Patients (Consumer Watchdog)

United Healthcare Insurance Company, OptumRx Inc., et al. v. John Doe (U.S. District Court, Central District of California) (pdf)

Insurer Suspends Mail-Order Drug Plan after HIV/AIDS Patient Lawsuit (by Ken Broder, AllGov California)

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