ACA lawsuit challenges insurer’s prescription delivery system

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Closeup photo of a group of multiracial hands holding red AIDS awareness ribbons.

HIV/AIDS

A federal class-action lawsuit filed April 27 accuses one of the nation’s largest health insurance companies of discriminating against patients with HIV/AIDS in its prescription drug policies.

Until recently, patients with HIV/AIDS prescriptions could purchase their drugs either through the mail or at their local pharmacies. CIGNA, however, now classifies purchases of these drugs as “out-of-network payments,” rather than “in-network payments,” meaning that it will only cover the cost of purchases made via mail delivery.

Therefore, people seeking to continue receiving prescriptions at pharmacies will have to pay the full purchase price, which often runs into the thousands of dollars for certain drugs.

“For all but the wealthiest HIV/AIDS patients, such dramatic cost increases and/or reduction in or elimination of benefits of coverage are untenable and thus many Class Members are left with no choice but to risk their health and privacy by obtaining their life-sustaining medications by mail,” the lawsuit states.

Under the Affordable Care Act, health insurance companies are barred from discriminating against patients on the basis of preexisting conditions.

In the lawsuit, Consumer Watchdog, Whatley Kallas LLP and Podhurst Orseck argue that CIGNA’s mail policy discriminates against patients with HIV/AIDS by exposing them to a range of unnecessary risks, including a loss of privacy, the benefits of consistent interaction with community pharmacists, and the threat that patients will not receive refills on their drugs before their prescriptions runs out.

‘By requiring HIV/AIDS patients to access their life-sustaining medications through a mail-order program that threatens their health and privacy, the mail-order requirement operates as a constructive eviction from coverage and thus erodes ongoing eligibility to receive medications,” the lawsuit states.

The lawsuit, filed in the U.S. District Court for the Southern District of Florida, also includes claims under the Americans with Disabilities Act and the Employment Retirement Income Security Act.

Consumer Watchdog reached settlements in similar lawsuits – Anthem Blue Cross, in May 2013, and United Health Care, in May 2014. In both these cases, patients may now opt-out of the mail order delivery system for HIV/AIDS drugs.