HIV Patients Defeat the United Healthcare Goliath to “Opt Out” of Mail Order Pharmacy

mailorder

mailorderOn March 19th United Healthcare agreed to settle the class action brought by United Healthcare members with HIV/AIDS who had been forced to abandon their local trusted HIV Pharmacies and utilize United Healthcare’s mail order pharmacy, OptumRx.

HIV therapy is complex and the role of the pharmacist in helping people manage their medications is critical. Clients have built trusted relationships with their local HIV pharmacists over many years and the pharmacists play a pivotal role in helping clients remain healthy and have improved quality of life. Pharmacists work directly with clients, monitoring potentially life threatening drug-drug interactions and side effects, while working with clients and their families to navigate the increasing insurance challenges and other challenges to living with a chronic illness.

Patients, providers and advocates alike are very concerned with the forced use of mail order pharmacies with concerns over loss of privacy, delivery concerns, medications not arriving on time, no strong relationships with HIV pharmacists and a constant stress and worry of not getting medications on time.

The United Healthcare proposed settlement applies to individual and employer provided health plans across the United States and allows people to opt out of a wider range of medications besides HIV antiretroviral such as anemia, growth hormone and neutropenia medications.

Retail pharmacies within the United Healthcare network will not be penalized because the pharmacy dispenses HIV/AIDS specialty medication to a United Healthcare member who exercised their right to opt out of the mail order pharmacy

Thanks go out to Jerry Flanagan the lead attorney at Consumer Watchdog who filed the lawsuit in June 2013 alleging that United Healthcare’s mail order requirement illegally targeted HIV/AIDS patients.

Consumer watchdog has now successfully sued Anthem Blue Cross and United Healthcare over the mandatory mail order requirement. In order to avoid lawsuits against individual insurance companies in the future it is important to support legislation at the state and federal level that could institute protections for people with HIV regardless of their insurance provider.

One such law to support is AB 2418 authored by California Assemblywoman Susan A. Bonilla  and co-authored by the California Pharmacists Association promoting medication adherence. One of the issues that this law addresses is to allow patients to opt out of their health plan’s mandatory mail order program if they prefer to obtain their prescription drugs from a community pharmacy.