Advocacy Group Says Anthem Blue Cross Pharmacy Program is Discriminatory

The advocacy group Consumer Watchdog has filed a statewide class action lawsuit against Anthem Blue Cross saying the health insurer is discriminating against HIV/AIDS patients.

Anthem is changing its pharmacy program and will require anyone using drugs from a list of "specialty" medications to use a mail-order pharmacy, approved by Anthem. But patients seeking to fill other prescriptions may still use their local bricks-and-mortar pharmacy. "That's exactly the kind of targeting and discrimination barred under the Civil Rights Act in California," Consumer Watchdog attorney Jerry Flanagan says.

In a statement, Anthem denies the change is discriminatory, because the list of specialty medications includes not only HIV/AIDS drugs, but also medicines for other conditions, such as cancer and multiple sclerosis. Anthem says that the practice is already established. From Anthem's statement:

"For many years, health plans in California and other states have sought, subject to certain exceptions, that specialty drugs be filled by Specialty Pharmacies and received via confidential home or other private delivery location that benefits the member. ... This is being done with the knowledge of our regulator and applies to several hundred different drugs for many medical ailments.  Anthem's policies do not discriminate on the basis of disease states, and they are reasonable and compliant with applicable laws."

Marta Green at the Department of Managed Health Care confirmed that there are three similar programs already in place in California from Health Net, Sharp and United Health Care of California. Green declined to comment on Consumer Watchdog's lawsuit, saying the Department had just received it.

In its statement, Anthem pointed to costs savings as one driving factor. "This program allows our contracted specialty pharmacy to secure bulk discounts for high cost drugs that help keep the benefit more affordable," the statement reads. Anthem also says that the mail order pharmacy it contracted with has a special program for HIV/AIDS patients, and evidence shows that patients in the program have a 93 percent drug adherence rate, "nearly 10% higher than patients using a retail pharmacy."

But Flanagan notes, "Consumers can't be drug compliant if they can't afford the drug."

He points out that many low and middle income HIV/AIDS patients depend on payment assistance programs established between pharmaceutical companies and retail pharmacies. These programs help pay for deductibles and co-pays. One patient participating in the lawsuit -- who goes by John Doe for confidentiality purposes -- has already incurred hundreds of dollars in out of pocket expenses, Flanagan says.

David Lazarus at the LA Times took a close look at the legality of the move:

"California law clearly states that no one can be discriminated against because of a medical condition," said Lynda Gledhill, a spokeswoman for Atty. Gen. Kamala D. Harris. "If patients are being required to get their prescriptions from a certain pharmacy because of their condition, that is likely illegal."

Anthem says that any patient who faces a hardship because of the new requirement may request an exception to the proposal.