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Anthem Blue Cross Settles Mandatory Mail Order Lawsuit on HIV Medications

By Michelle J. Sherman, R.Ph., A.A.H.I.V.P.

June 6, 2013

On May 23, a settlement was reached in San Diego Superior Court in the lawsuit brought against Anthem Blue Cross when Anthem instituted mandatory mail order on HIV specialty drugs.

Download the settlement here.

The mandatory mail order would have serious risks to HIV patient health and safety, as well as threats to their privacy. Community HIV Pharmacies that have HIV-credentialed pharmacists and sensitive, caring staff can continue to provide exceptional care to their HIV patients, with whom they have built strong relationships, built on care and trust for many years.

As the result of a settlement in a recent lawsuit, Anthem Blue Cross has agreed to provide a simple "opt-out" option for patients who wish to remain with their local community pharmacy. That policy permits patients to opt out for any reason by calling a dedicated phone number. This provision went into effect June 1. Patients will have until August 1, 2013, to make their request to opt out of the mail order program.

Download the sample letter here.

The HIV pharmacist is a key member of the patient's health care team and will now work with their Anthem Blue Cross patients to educate them on the importance of face-to-face health care counseling from pharmacists specializing in HIV/AIDS, and help their patients understand the opt-out process.

Legislative action has also been initiated in California and the California Pharmacists Association (CPhA) has introduced a bill to the California Legislature known as AB 299 (Holden) to put an end to mandatory mail programs and give patients a choice with mail order. John Roth, CEO of CPhA, said:

Automatically enrolling patients into a mail order pharmacy program takes away a patient's right to select the option that best fits their health care needs and could negatively impact their therapeutic outcome. With AB 299, patients who prefer to have their medications mailed to them will still have that option, but those who want to maintain their patient-provider relationship with a community pharmacist whom they personally know and trust, will be able to do so as well. AB 299 is a win-win solution for all patients.




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