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.
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.