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Anthem Blue Cross Sued Over New HIV/AIDS Drug Policy

— A prominent consumer group is suing Anthem Blue Cross over a new policy that requires HIV patients to get their medications by mail. A San Diego man who's HIV positive is the lead plaintiff.

Aired 1/15/13 on KPBS News.

Anthem Blue Cross's new policy requiring HIV/AIDS patients to get their drugs by mail order has prompted a lawsuit charging the move is discriminatory.

Jon Jones, which is not his real name, has a PPO plan with Anthem Blue Cross.

A few months ago, the insurer informed Jones of their new policy: It would no longer allow HIV patients to get their medications at a local pharmacy. Blue Cross would only provide the drugs via mail order.

"Why they didn't include my heart medication, bladder, any of that, I don't know, but just strictly the four HIV drugs I take," Jones said.

Jones asked Blue Cross for an exemption. The company refused.

The non-profit group Consumer Watchdog is suing the insurer on behalf of Jones and other HIV patients. Staff attorney Jerry Flanagan said the new policy is illegal.

"This is a classic case of Blue Cross treating people different based on their health condition, specifically targeting consumers who are HIV/AIDS positive. And that's a violation of the Unruh Civil Rights Act," Flanagan explained.

A company spokesman said Anthem's new policy saves money and is compliant with the law.

Jones likes to be able to talk with his local pharmacist about drug interactions. He doesn't want to give that up.

"I feel very much discriminated against. I don't know, I feel bullied by it, actually, " Jones said.

The policy is set to begin in March. Consumer Watchdog is asking the court for an injunction to block the change.

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Avatar for user 'DocsWife'

DocsWife | January 15, 2013 at 3:20 p.m. ― 4 years, 2 months ago

Can we get the WHOLE story here?! Has it occured to anyone that Blue Cross has done this because these particular drugs are unbelieveably expensive and maybe the by-mail pharmacy saves the insurance company money? Whether or not that means more profit for them or lowered costs to the consumer, let's not jump to any erroneous conclusions. (No, I DON'T work in the insurance or medical industries.)

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Avatar for user 'RegularChristian'

RegularChristian | January 15, 2013 at 5:25 p.m. ― 4 years, 2 months ago

Sounds like BLue Cross is treating this "member" as poorly as they treat all their members.

There's just is no place for profit in the health insurance industry. It's a risk pool, not a business. If these multi millionaire senior executives want to use a business model where they can earn gobs and gobs of money, they should go in to some other industry where profits aren't made from people's misery.

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Avatar for user 'Peking_Duck_SD'

Peking_Duck_SD | January 15, 2013 at 7:57 p.m. ― 4 years, 2 months ago

DocsWife, many types of medications are extremely expensive. Look at insulin and diabetes test strips for example. Are insulin-dependent diabetics forced to do this too? If it's ONLY for HIV meds, then the high cost argument doesn't hold water because many drugs are expensive. Plus, the consumer should be allowed to have the choice of going in to a pharmacy if that's what they prefer.

RegularChristian, I agree with your thoughts about insurance companies which is why I support a single-payer gov. controlled healthcare system in this country.

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Avatar for user 'RAtrucker'

RAtrucker | February 8, 2013 at 1:38 a.m. ― 4 years, 1 month ago

DocsWife, have you ever had to order your meds through Express Scripts? If so you will quickly find out how Anthem saves so much through mail order. Take a look at this site and maybe you'll get a clue

or maybe this one

or this

I have rheumatoid arthritis and had to use these horrible pbms. They save money for Anthem by delaying orders for days, weeks, and months. When I changed from Humira to Enbrel I was preappoved but it still took 32 phone calls over a period of 4 days to finally get it ordered and shipped. They made my rheumatologist fax them 3 different times and finally she had to call them. Then they tried to say that the rx was written for 4 pre filled syringes but they could only cover 3.92. After more phone calls I realized that they were taking the ml of .98 in each syringe and multiplying it by 4 to come up with 3.92.......unbelievable!!!!! Enbrel comes as 50mg in a solution of .98ml. This is the kind of stuff I had to deal with almost every month when it was time to order. I dreaded it. It is bad enough to have a chronic illness- but to be treated like dirt by these people is horribly wrong.

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