Meds, Mind, Body & Benefits > Insurance, Benefits Programs & HIV

Confidential patient services. Agent for pharmacy?

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creative1:
I'm new here, though not new to being HIV+, having begun taking meds over 10 years ago. I wanted to get feedback here about something I haven't been able to find enough information about. Bear with me, this is long (and I still have much more than this to say on the subject.)

I was approached, at a Los Angeles HIV support group event, about signing up for what they call a confidential patient services plan. They work with HIV patients to get them their medications, delivered by courier, and they also sponsor a number of social activities. (That's the part that initially intrigued me.)

As it was explained to me, they work with pharmacies who pay a fee for having patients steered to those pharmacies. This is at no cost to the patients. The pharmacies are paid (for the medications) by the insurance companies and ADAP. And the "service" is paid by the pharmacy. They are like agents for the pharmacy.

They also cover the costs of supplements (vitamins, etc.) and for the co-pay on medications that aren't covered by ADAP.

I called the pharmacy (the service say there's "a network of pharmacies", but I think there's just one), to ask who pays for that cost, the pharmacist said they offer that as a "courtesy to you guys" Which I guess implied that the pharmacy absorbs the cost, in exchange for the large monthly profit they get from having all these HIV patients they wouldn't normally have gotten. This pharmacy is in Orange County, well outside Los Angeles. The "service" has recruited their clientele largely from the West Hollywood community (the central gay hub of Los Angeles), patients who have numerous alternatives to using this pharmacy (or this service).

So, I'm trying to determine if this is above boards. Are pharmacies allowed to have "agents" for their business? I know AHF in L.A. offers cell phones and Metro passes as incentives to patients who choose them as their medical treatment providers, but not to those who just use the pharmacy.

Does this "patient service" sound like a legitimate business? I'm discovering things that make it all sound fishy to me, and possibly illegal. I'm going to see if I can speak to someone at my insurance company and ADAP about it. I'm thinking of also contacting the Department of Consumer Affairs - California Board of Pharmacy.

I realize that I can just walk away and not participate. But I wanted to see what folks on this message board had to say about it. It's one thing to choose not to participate and quite another thing to see others possibly taken advantage of and not do anything about it. If the "service" has hundreds of participants, as they claim, and are getting monthly payments from the pharmacy, it seems they are making thousands and thousands of dollars a month off the patients -- literally reaping our benefits.

What do you think?

emeraldize:
Follow your instinct. I think inquiring with the Board is wise. And, discuss it with someone you trust, perhaps your own ID doc, to ensure you're not setting yourself up for any unforeseen breach of confidentiality possibilities. Your doc might have an interesting perspective to offer and will want to protect you.

creative1:
Thanks for the response. Hmm, I was thinking I might hear from more people on the topic.

I have an upcoming appointment with my doctor. I haven't yet contacted the Dept. of Consumer Affairs, but I will. I did speak with a social worker, who said both the pharmacy and the confidential patient services agent sounded like a suspicious arrangement.

It's been somewhat difficult to get clear answers, but as a friend told me "somebody needs to go all '60 Minutes' on this." So, I'm going to continue to see what I can find out.

Ann:
Hi Creative, welcome to the forums.

I think you probably didn't get many responses because so few people have even heard of this program. I agree - it sounds suspiciously like a scam.

Please keep us informed as to what you find out about it. If it is indeed a scam of some sort, then we need to get the word out.

Ann

Idlewild_74:
It has been awhile since this was initially posted but I use CPS and can maybe add some light.

They are essentially the New Kids on the Block.  They are totally legit.  I have been receiving my meds through them for more than a year now having joined shortly after they started.  I've never had a problem and have found they will even go out of their way to insure I get my meds even if the delivery isn't at home. 

In addition to the med deliveries their representatives will occasionally put together an event for their clients.  Like hikes, trips to the beach, bowling, ect.  On a more serious level they also will help you wade through the govt bureaucracy to get access to local services like housing ect ect.... 

Recently they have actually expanded beyond just the meds.  They opened a clinic now staffed by a well known local HIV specialist.  The clinic is really close to downtown.  (I've only been there once so far so don't remember the address off the top of my head.)  The clinic offers occasional group meetings, chiropractic services and acupuncture.  I went once for chiropractic services.

I am considering switching over to their clinic because they are working on massage therapy, dental, and vision programs as well. But my rep thinks you have to be a part of the clinic side to gain access to this stuff.  Its still a bit fuzzy since these programs are still being figured out.

What I really like is that you get personal reps who go out of their way to stay in touch with you and help you in any way within their ability.  I even know of one example where the reps helped a client move to a new apartment.  They actually showed up and helped move boxes!!!...  That is saying something.

Ultimately like I said they are the New Kids on the Block and they are shaking up the treatment model being used by current providers.  Something that ultimately can only lead to more competition and better services for all of us in the long run. 

I hope this helps. 

 

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