Is Anthem Blue Cross’ Mail-Order Drug Requirement Discriminatory?

Anthem and its parent company Wellpoint have been nominated multiple times for Consumerist's Worst Company In America.

Anthem and its parent company Wellpoint have been nominated multiple times for Consumerist’s Worst Company In America.

Anthem Blue Cross, the largest for-profit health insurance in California, will soon require that patients with some conditions can only get their prescriptions through a single mail-order pharmacy. However, some state officials think this could be against the law.

The L.A. Times’ David Lazarus reports that Anthem has started notifying patients with HIV/AIDS and cancer that they must use mail-order pharmacy CuraScript or pay full retail price for their meds. This condition is not placed on policyholders with other conditions, even chronic ailments.

As such, the California Attorney General’s office believes this might qualify as a discriminatory practice under state law.

“California law clearly states that no one can be discriminated against because of a medical condition,” a rep for the AG’s office tells Lazarus. “If patients are being required to get their prescriptions from a certain pharmacy because of their condition, that is likely illegal.”

The AG wouldn’t say what, if anything, it will do if Anthem goes through with the policy change, slated to go into effect on March 1. It had been scheduled to start at the beginning of 2013, but pushed the date back after the California Department of Managed Health Care expressed its concern that the insurer hadn’t done enough to notify affected customers.

In a statement to the Times, Anthem, which has said the change is intended to keep costs down for patients, claims that the new requirements “do not discriminate on the basis of disease states, and they are reasonable and compliant with applicable laws.”

Also of concern to some is whether or not Anthem is doing its best to explain to policyholders that there are exceptions to the mail-order requirement and that patients can apply for a hardship waiver.

“That was our primary concern,” a spokeswoman for the Department of Managed Health Care tells Lazarus. “There are individuals for whom a mail-order pharmacy may not be appropriate.”

Lazarus gives the example of patients who take multiple medications and would be better served by human interaction with a pharmacist.

“You may have to take [the drugs] in a particular order or at particular times,” explains a lawyer representing retail drugstores. “As you go, you may have to adjust your doses. Not being able to speak with your own pharmacist can have very serious repercussions.”

The Anthem rep says the company is doing more to make people aware of the waiver and provided the Times with a copy of the revised notice being sent out to affected policyholders. At the bottom of the notice, it reads, “if this specialty mandate poses a hardship for you, you may file a grievance with Anthem” or request a form to seek an exemption.

Lazarus suggests the alternative option to the all-or-nothing policy change proposed by Anthem: “Offer a discount for shopping at the pharmacy of Anthem’s choosing, but don’t punish people for going to the same drugstores that all other members are free to use.”

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