Anthem suspends controversial Calif. mail-order specialty pharmacy policy

Policy would have required HIV patients to receive drugs through mail

NEW YORK — Anthem Blue Cross will indefinitely suspend a policy that would require many specialty pharmacy patients in California, most of them HIV patients, to receive their drugs via mail order in order to receive coverage for them, drawing criticism from patients and retail pharmacies.

In November and December, thousands of Los Angeles patients covered by Anthem Blue Cross received letters stating that starting Jan. 1, 2013, their drugs would only be covered if they obtained them through CuraScript, a mail-order pharmacy owned by PBM Express Scripts, while those who continued to use retail pharmacies would have to shoulder the full cost of their drugs. The date for the new policy to take effect was later postponed to March 1.

On Jan. 11, the consumer group Consumer Watchdog and law firm Whatley Kallas filed a class-action suit against Anthem on behalf of the patients, alleging that the policy discriminated against HIV patients by only forcing them to use mail order, while allowing other subscribers to use the pharmacies of their choice, thus violating California's Unruh Civil Rights Act.

Calling Anthem's decision to suspend the policy a precedent-setting action, the Law Offices of David Balto, which also had advocated on behalf of the patients, said it marked the first time consumers and pharmacies had been able to force an insurance company or PBM to reverse its mandatory mail-order policy.

"Anthem's actions would have harmed thousands of vulnerable HIV patients, preventing them from receiving the first-rate health care they need and deserve," Balto, a former policy director for the Federal Trade Commission under the Clinton administration who brought some of the first cases against PBMs, said. "Study after study has demonstrated that pharmacies that specialize in serving HIV patients deliver better service, improve health care and lower healthcare costs. This is a landmark achievement in consumers' and pharmacies' ongoing battle against restrictive healthcare networks. Anthem's decision to suspend their policy preserves patients' choice and will need to better healthcare results."

Anthem had defended the policy, saying it would help moderate healthcare costs and saying that home delivery of prescription drugs could improve medication compliance.

"In response to feedback that has been conveyed by our members, which we are in the process of evaluating, we are delaying the March 1 changes in the specialty pharmacy program," Anthem spokesman Darrel Ng told Drug Store News. "We value the input of our members."

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