HIV patients losing access to pharmacies in CA

[publicinterest]

Hello community,

I wanted to alert you to a situation taking place in California. Thousands of HIV patients insured by Anthem Blue Cross of California have received letters in the last few weeks saying that effective January 1, they have to stop going to their current pharmacy, and start receiving their prescriptions through the mail, or pay the full price of the drugs out of pocket. This a terrible situation for HIV patients, and Anthem Blue Cross has to reverse their decision if their goal is to maximize patient health.

If you know anyone who has received this letter, ask them contact Anthem Blue Cross to file a grievance. Here's Anthem's contact info: http://www.anthem.com/wps/portal/ca/visitor?content_path=visitor/f4/s1/t1/pw_a116272.htm&label=Contact%20Us

Below is an article that describes how serious this situation is for HIV patients. Please spread this link!

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http://www.huffingtonpost.com/david-balto/specialty-drugs-mail-order_b_2245134.html

Cutting Off Essential Health Care for HIV Patients: The Latest Managed Care Scheme

Posted: 12/06/2012 3:10 pm

The holiday season is a time to reflect on and cherish our relationships with family, friends, and others that we interact with every day. But for thousands of HIV patients in Los Angeles, this holiday season will mean the loss of the critical relationship they have with their local specialty pharmacist.

In the last few weeks, health insurer Anthem Blue Cross began to notify thousands of HIV patients that starting January 1, they will no longer be able to receive their medication and care from their local pharmacy. Instead, they'll have to order their drugs through the mail from CuraScript, a mail-order pharmacy based in Florida and owned by Express Scripts, the nation's largest pharmacy benefit manager (PBM).

Mail-order pharmacy may sound good, but it comes at a stiff price for patients, the government, and employers who pay for the drugs. For patients that take specialty drugs (expensive medications that treat serious, chronic diseases like HIV, cancer, and hemophilia), mail order isn't just expensive, it's simply not a viable option for care. Specialty patients often have many prescriptions that treat and manage their diseases, and it's critical the drugs be taken on schedule and in the right order and are properly administered, or there can be dire consequences. For an HIV patient, waiting for another shipment when a prescription gets lost in the mail or the wrong drug is delivered isn't an option.

Not surprisingly, when mail order screws up, as it often does, the consumer must rely on her community specialty pharmacy to help out. Specialty pharmacies, the pharmacies that carry these rare, expensive drugs, build strong personal and clinical relationships with their patients, making sure that they receive the drugs they need when they need them. Most also provide a full slate of advising and counseling services to help patients and their families navigate the challenges of living with a chronic and often debilitating condition. Many specialty pharmacies also have programs to help low-income patients afford their ever rising co-pays. That's why patients lose when they are forced into mail order.

But wait -- some may say mail order will save the health plan money. But the reality is that mail order leads to tremendous waste, and the PBMs make money by dispensing as much as possible at the highest cost. Patients are frequently delivered the wrong medication or too large of a supply that they can't use, running up needless costs that get passed on to the payor of the patient's plan, which is usually their employer, and ultimately to the patient.

Even more crucial than the difference in cost for HIV patients forced into mail order is the loss of the clinical relationship they have with their pharmacists. Specialty pharmacists are experts not only at dispensing medications, but also identifying and preventing the potentially dangerous interactions between different drugs. Many HIV patients take a large number of different drugs each day just to treat their HIV, in addition to prescriptions they may have for other conditions. It's critical that they have a local pharmacist who knows their treatment regimen, their lifestyle, and their medical history, to ensure they get the care they require and that their health isn't endangered. Although progress has been made in treating HIV since its discovery three decades ago, if treated incorrectly or incompletely, HIV can drastically and quickly reduce a patient's quality of life, or worse.

To compensate for taking away access to their local pharmacy, Anthem is essentially offering to HIV patients an anonymous, uninterested voice at a 1-800 number that almost certainly won't know a patient's history and won't be able to provide remotely the same level of care as a local pharmacist. This may be nothing short of catastrophic for the thousands of patients who are affected, and is trivial and superficial compensation for disrupting a successful model of patient care for a vulnerable population.

HIV patients can't afford to have their insurance company put profits in front of their health. For most conditions, switching patients to mail-order drug delivery is just questionable corporate conduct; for HIV patients, it's a critical hazard for their health and well-being. Anthem must reverse their decision immediately. If not, California Attorney General Kamala Harris should take action to stop this effort to profit from these most vulnerable patients.

[Denver Toad]

Overblown generalizations and sensationalism at best.

I've BCBS as an insurer and have had NO problem with mail order. Never had a lost script, if on auto re-order receive a week early, any pharmacist (CVS or Walgreens in my case) is always glad to answer questions. Just p/u the phone. Added benefit, I have plenty of meds on hand should the need/opportunity to travel arise. Beats the hell outta having no insurance.

Lastly, seeing as this is your first post why don't you stop by in Living With and introduce yourself. It would lend credence to subsequent postings.

[bocker3]

I agree with Denver Toad -- this is simply unwarranted outrage.  I've used mailorder  pharmacies for all my time positive, until the last year.  Rarely had issues (only 2 in 6+ yrs) -- so long as one plans accordingly, it should not become an emergency.

Just the title is overblown - these patients are not losing access to pharmacies at all.  They can still access a pharmacy, get their drugs and have their insurance pay the bulk of the cost.  Yes, they have to use specific pharmacies, but so be it.  People piss and moan about the cost of health care and then when the entity paying for the majority of the cost does something to help contain it people scream.  You can't have it both ways.  If you want total freedom, then pay for it.  Else, be glad that BC is trying to cut costs and thereby limit your premium increase.

Mike

[Jeff G]

This is an interesting subject . I do think an introduction would be helpful , its always good to know why a new member comes on board with an issue such as this and if they are representing a group or lobby or living with HIV themselves . 

 

[Mrmojorisin]

I get my meds delivered by mail, never had a problem...this is just trying stir the pot...

[madbrain]

I don't have any problem with getting my refills in the mail with Kaiser.
However, there are many situations for which they are not suitable. Meds can get lost, stolen, damaged, etc. In all those situations I would not want to be told to wait for a mail order pharmacy.

Mail order does not seem appropriate for initial prescriptions either. If somebody needs meds right now - say, they just got diagnosed, and their initial tcells came back very low - they should get the meds the same day. They should not have to wait for them in the mail.

I'm with the OP on this one. But at the same time, I also wonder if the OP is HIV+ and why they suddenly jumped in here.

[bocker3]

I don't have any problem with getting my refills in the mail with Kaiser.
However, there are many situations for which they are not suitable. Meds can get lost, stolen, damaged, etc. In all those situations I would not want to be told to wait for a mail order pharmacy.

Mail order does not seem appropriate for initial prescriptions either. If somebody needs meds right now - say, they just got diagnosed, and their initial tcells came back very low - they should get the meds the same day. They should not have to wait for them in the mail.

I'm with the OP on this one. But at the same time, I also wonder if the OP is HIV+ and why they suddenly jumped in here.

I seriously doubt that you have to use the mail order for an initial Rx -- mail order is for maintenance and it ain't maintenance until you start.  Every mail order pharmacy I've been part of -- allows retail filling of the initial 30 days (even an emergency script can be filled at a retail Rx in every plan I've been in -- all you need is a doctor to write it that way).  I still think this OP is just stirring the pot.

M

[madbrain]

I seriously doubt that you have to use the mail order for an initial Rx -- mail order is for maintenance and it ain't maintenance until you start. 

Well, the article doesn't specifically say that this new requirement is for refills or maintenance prescriptions only. It would be interesting to see a copy of the letter that patients received and what its wording is.

Every mail order pharmacy I've been part of -- allows retail filling of the initial 30 days (even an emergency script can be filled at a retail Rx in every plan I've been in -- all you need is a doctor to write it that way).  I still think this OP is just stirring the pot.

Right. I don't think think filling it is the issue here, so much as having it covered by insurance.

My Kaiser doctor can write a prescription that I can fill at any retail pharmacy also, however the terms of my Kaiser plan are quite clear that they only cover prescriptions at Kaiser pharmacies, and nowhere else.

[RapidRod]

My scrips are mailed "UPS or Fedx" via CVS CareMark and in the 7 years have never had a lost or late shipment.