Advertisement
The Body: The Complete HIV/AIDS Resource Follow Us Follow Us on Facebook Follow Us on Twitter Download Our App
Professionals >> Visit The Body PROThe Body en Espanol

Stop Anthem Blue Cross From Compromising Care of HIV-Positive Clients

January 17, 2013

In California, Anthem Blue Cross is forcing HIV-positive clients to use their mail order pharmacy, Curascript, which is owned by the giant prescription benefit manager (PBM) Express Scripts, which will severely compromise the care of clients. I have created a petition at Change.org to challenge this practice, and I encourage all those interested to sign.

Community HIV specialty pharmacies have been providing excellent care to HIV-positive clients for 30 years, managing the patients' drug therapies to avoid potentially fatal drug-drug interactions, help clients with adherence, ensuring that clients take their medication every day so they do not develop resistance to HIV medications, and also providing education on an array of other issues critical for an HIV-positive client's quality of life and well being, such as linkage to other services within their community. Clients have forged relationships with their HIV pharmacists, whom they know, like and trust, and who have become crucial health care providers on the care teams of clients living with HIV.

Clients have been working with their HIV pharmacists and physicians to submit Specialty Pharmacy Exception forms to Anthem Blue Cross, so that they may continue to use their pharmacy. This has been a tedious process and in many cases clients have been denied the exception without explanation and have then had to file a grievance with the insurance company.

Advertisement
Drug therapy is at the bull's eye of treatment strategies for HIV-positive clients, and Anthem Blue Cross is putting lives at risk by mandating that they use the mail order pharmacy. Stress has been shown to have a negative impact on a person's immune system; therefore the stress that the insurance company is placing on clients can make them sicker, and in fact put their health at risk. By utilizing the mail order pharmacy, where medications are very often delivered late, the pharmacy is also compromising the health of clients by promoting non-adherence and not having HIV specialist pharmacists that can interact with the clients.

As I and my colleagues have observed, HIV-positive clients do not want to switch to Anthem Blue Cross's pharmacy -- and their care will be severely compromised as many have already experienced the horrors of mail order pharmacy in the past. Anthem Blue Cross and Express Scripts want you to believe that having them fill the prescription, removing the client's choice and stopping the patient from getting their prescriptions from their local, trusted, expert pharmacist, will be cheaper and cut down on health care costs. This couldn't be further from the truth. What it does is compromise patient care and put hundreds of millions of dollars into the pockets of the insurance companies and PBMs so that they can get bigger checks and bonuses, while clients get sicker and may even die.

Here are some examples of stress placed on clients:

  • The mail order pharmacy does not accept copay assistance cards that put an additional financial burden on clients who have to use the pharmacy. Keeping clients in the care of their local HIV expert pharmacists is what will ultimately decrease health care costs and keep clients healthier. If HIV-positive clients choose to remain with their local pharmacy they will have to pay 100% of the cost of the drug, which would be thousands of dollars a month.
  • HIV-positive clients are being harassed by Curascript to switch pharmacies. One clients spoke to a pharmacist at Curascript who told him: "The reason it's better to get my meds from Curascript than my local HIV pharmacy, is that my local pharmacy does not keep the drugs in stock and it takes them days to get it." The client is so outraged and beside himself, he no longer answers his phone. He has now filed a grievance with Anthem.
  • Another client told Curascript he has a post office box (P.O. Box) where his mail goes and they said they don't mail to P.O. Boxes; they could mail it to his work or to a neighbor (really ... what about confidentiality?). He said he most definitely does not want his medication mailed to work or a neighbor.

Anthem, as well as other health insurance companies such as Empire BlueCross BlueShield, have also mandated clients to get their HIV medications through mail order. Two states, New York and Pennsylvania, have passed laws that mail order cannot be mandatory but only a choice. A lawsuit has just been filed in California against Anthem Blue Cross for a wide array of infractions including violation of California's Civil Right's Law (Unruh Act).

Again, I encourage you to sign the petition created at Change.org to stop Anthem Blue Cross from compromising the care of its clients living with HIV.

Michelle J. Sherman is a nationally recognized HIV specialist pharmacist practicing in Orange County, Calif.



This article was provided by MichRx.
 
See Also
More Calls to Action
Advertisement:
Find out how a Walgreens specially trained pharmacist can help you

Reader Comments:

Comment by: Kerri (NY) Tue., May. 21, 2013 at 2:07 pm EDT
Does anyone know of any action taking place in New York to stop Empire BCBS from reclassifying HIV meds as "specialty prescriptions" and forcing patients to use Curascript? I've spent hours on the phone with Empire begging to be allowed to use my existing pharmacy, and we really need to get this changed. Class action lawsuit? Petition? Something?
Reply to this comment


Comment by: Philip D. (San Francisco, CA) Tue., Feb. 19, 2013 at 4:40 pm EST
As an Blue Cross/Anthem member for more than 20 years, I see this move as just another way to I'm forced to "bend over and take it". In the first two months since switching to Curascript, I've already experienced a delay in receiving my medications. I can't receive them at my home, so I have to strategically plan to make sure someone at my workplace will be there on the day and time they decide to deliver them. Until then, I'll just keep passing the Walgreen's I've used for years, that's open 24/7 Can't help wondering if Anthem at least plans to practice safe sex, the next time they plot to screw the members they claim to care for.
Reply to this comment
Replies to this comment:
Comment by: Michelle Sherman (Dana Point, CA) Wed., Feb. 20, 2013 at 8:54 am EST
Philip good news!You can go back to your Walgreens and get the care that you are used to. On February 15th 2013, Anthem Blue Cross announced hat it would put on indefinite hold it's plans to move all HIV/AIDS, and other specialty drugs, to mandatory mail order service.
We have VICTORY for now, thanks to all your efforts, and the tireless work of HIV Pharmacies, HIV clients, advocates and people just doing the right thing.
Keep fighting and pushing on so that "indefinite" becomes forever!


Comment by: amanda (pittsburgh ps) Wed., Feb. 13, 2013 at 1:27 pm EST
I live in pa and I am being told I have to order my meds mail order. Do you have any info on the law pa has saying I have a choice. I have already had a traumatic experience regarding mail ordering.
Reply to this comment
Replies to this comment:
Comment by: Michelle Sherman (Dana Point, CA) Wed., Feb. 13, 2013 at 8:40 pm EST
Ask your local pharmacist about PA SB201 which is the law that went into effect in Pennsylvania


Comment by: Informed advocate (US) Sat., Feb. 9, 2013 at 12:34 am EST
The idea that the use of. Curascripts causing non-adherence is misinformed. One of the core philosophies that drive Express Scripts is therapeutic adherence. With Express. Scripts' acquisition of Medco they stand to benefit from the valuable resources from Accredo. Express Scripts has already announced that Curascripts will be converted to the Accredo name and they are looking at taking best. Practices from both organizations as the work to integrate. The pharmacies and pharmacy benefit managers such as Express Scripts are not to blame for plan limitations. To a 30 day supply. These types of limitations are put into place by insurance companies like. Anthem. Companies like Express Scripts are then brought on to administer and enforce these plans. If you truly beleve Express Scripts/Curascripts promotes non-adherence. I encourage you to check out all the research and innovation these companies. Have done in these areas. http://www.express-scripts.com/research/
Reply to this comment
Replies to this comment:
Comment by: Michelle Sherman (Dana Point, CA) Wed., Feb. 13, 2013 at 8:47 pm EST
When client after client comes into their local pharmacy frantic because they have not received their prescriptions in the mail and they missed doses of their antiretrovirals this is non-adherence being promoted by the pharmacy. This is the reality of many clients who have to use mail order pharmacies. Research by Express scripts still does not account for the reality of what's going on with many clients


Comment by: Drew (Atlanta, Ga) Fri., Jan. 18, 2013 at 9:22 am EST
How does using Curascripts compromise patient's care? I have a friend who uses it for his HIV medicine and he's able to get a 90 day supply for almost nothing. This is a great program for people with HIV. It also gives him a level of privacy that he wouldn't have if he went to the normal pharmacy. I don't think you know what you're talking about.
Reply to this comment
Replies to this comment:
Comment by: Michelle Sherman (Dana Point, CA) Sat., Jan. 19, 2013 at 2:47 pm EST
@ Drew I have over 20 years of experience working with HIV clients. Having an HIV pharmacist help clients with drug interactions , side effects , and other major issues helps clients stay on their medications and stay healthy. Anthem Blue Cross provides only a 30 day supply of meds not a 90 day supply. I do agree with you that a regular pharmacy may not provide the same level of care and confidentiality as they may not specialize in HIV, that is why HIV clients should use HIV Specialty pharmacies where the pharmacists are HIV specialists and confidentiality is paramount. More often than not Curascript prescriptions are LATE in the mail thus promoting non-adherence in clients. Using Curascript may be fine for some but it should be a choice not a mandate. Would you see a doctor through the mail? The same holds true for ones pharmacist who is the gatekeeper of a persons meds, who when taken incorrectly can have catastrophic consequences
Comment by: leo (los angeles ca) Sun., Jan. 27, 2013 at 2:54 am EST
and you know what you are talking about because you 'have a friend who uses it'? let me enlighten you: i MYSELF am a blue cross of ca customer, for 20 years. i personally pay a $900+ monthly premium. i will be seriously affected by the change to curascript, and i am bring given no choice in the matter. adhering to a strict medication regime is no joke.. putting my LIFE in the hands of ups, some anonymous offshore 1-800-telepharmacist and curascript's shockingly bad customer service dept because i need one type of drug vs another, is discriminatory and dangerous. all of my other meds continue to be available to me at my in-network local pharmacy but the ones i need the most come (every month, on-time, hopefully) from somewhere else. who monitors potential cross reactions? what if the drugs are lost in transit? what if they are stolen from my mailbox? what if (and this is in fact my case) i can very rarely, for work reasons, be waiting at home to receive them? My career requires me to travel, and my pharmacist is as important a partner in my healthcare as my doctor is, i need them both. blue cross unilaterally declare that my benefits no longer include the same access to a regular pharmacy that other customers have, is discriminatory, and it worries me deeply. i have managed my health situation for 18 years without a problem, 100% because the drugs work and i have religiously kept up with them. you can not understand the stress this causes me, to think that because of blue cross imposing this stinking a**hole of a decision on me that my health might be compromised. i lose sleep over it.


Add Your Comment:
(Please note: Your name and comment will be public, and may even show up in
Internet search results. Be careful when providing personal information! Before
adding your comment, please read TheBody.com's Comment Policy.)

Your Name:


Your Location:

(ex: San Francisco, CA)

Your Comment:

Characters remaining:

Advertisement