Consumer Watchdog and Whatley Kallas LLC filed a federal class-action lawsuit against Aetna on December 19, charging the health insurance company with violating the Affordable Care Act’s anti-discrimination mandate in its new mail-order delivery system for prescription drugs for people with HIV.
“We are in an era where presumably we guarantee access to health insurance to anyone, regardless of their health history or disability,” Jerry Flanagan, staff attorney for Consumer Watchdog, told the New York Times. “Insurance companies are still in the business of insuring people for the highest premium they can, and keeping their medical expenses down.”
Prior to January 1, Aetna allowed patients pick up HIV prescription drugs from community pharmacies. Now patients must have the drugs mail-ordered, or pay thousands of dollars in out-of-pocket costs to continue receiving medications, at full price, at the community pharmacy.
For people receiving the drugs through mail order, Aetna is also imposing a 30 percent coinsurance charge, up to $150 per maximum per prescription. Previously, it was a fixed co-pay of $20-70 per prescription.
“For all but the wealthiest HIV/AIDS patients, such dramatic cost increases 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, which was filed in the U.S. District Court for the Southern District of California.
Since the drugs are often delivered in refrigerated containers, the change increases the risk that goods will be stolen, the lawsuit also argues. The change is also raising significant privacy concerns, as it increases the likelihood that others will learn about their condition.
In addition, the patients will lose the benefit of continued interaction with their community pharmacists and undergo unnecessary stress waiting for their medications. Since patients are not allowed early refills, they must reorder their prescriptions each month.
The lawsuit argues that these changes circumvent the ACA’s guaranteed access provision, which guarantees all patients access to health insurance regardless of their health conditions. It also lists a variety of claims under the Americans with Disabilities Act, state law, and various contract claims.
“Playing just-in-time inventory games with an HIV medication that requires nearly 100% compliance to remain effective to keep the virus under control is a short sighted business practice and a danger to my health,” said the lead plaintiff in the lawsuit, identified as John Doe in court papers, in a news release.