Tweet
In its quest for more profits, Anthem Blue Cross has begun telling patients who have very serious diseases and need so-called “specialty drugs” that they cannot use their local pharmacy where many have long term relationships, but must instead order their life-saving medications from a mail-order pharmacy.
As Los Angeles Times Consumer Columnist David Lazarus recently noted, specialty drugs are used for complex conditions and can cost thousands of dollars a month. Patients suffering from chronic diseases like HIV, cancer, and hemophilia use such medicines.
In the Los Angeles area HIV patients are particularly hard hit by Anthem’s unilateral decision that after Jan. 1, patients needing specialty drugs to treat their conditions must buy them from mail-order pharmacy CuraScript.
In a letter to patients, the insurance giant wrote:
“Using a retail pharmacy will be considered going out-of-network. And your plan doesn’t have coverage for that. So you’ll have to pay the full price of the drug.”
According to Lazarus Jacques Liberman, 57, of Cathedral City received one of the letters the other day. He is HIV-positive and takes a drug called Atripla to help prevent his condition from transforming into full-blown AIDS.
“Who is Anthem to tell me where I have to buy my medicine?” Lazarus quoted him as saying. “Why should I have to buy it from some mail-order company instead of the drugstore that I have been going to for a long time?”
But it’s more than just an in infringement on personal freedom. Patients who need specialty medicines suffer from complex disease that require complex treatment. The pharmacist is virtually a member of the treatment team offering advice and closely monitoring the patient’s condition.
David Balto, a Washington attorney who represents some of the specialty pharmacies, explains the relationship like this:
“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.”
Anthem proposes to replace that relationship with an 800 number. Anything for a buck, I suppose.
What’s not clear yet is what can be done to stop this abuse. Consumer Watchdog is investigating. If you’ve been affected by the change please let us know.
3 Comments
What I find troubling about this is the fact that the group of people being told this are people who can be quite ill. As someone who did elder and hospice care for close to twenty years, I can say that sometimes mistakes are made. If you have a drug store where the staff is attentive to you, they are easy to get a hold of and they can explain rather quickly that, yes, the pills that were blue last month are still blue this month, and the pills they received, the green ones, should come back.
I have had several very bad experiences with Anthem. I really think they suck. If they have a slogan, it is probably: “We love your premium moneys you send us – now go away!” But until we have a democracy, I really don’t know what we do?
A while back my wife’s BCBS insurer tried to make her switch to a mail-order pharmacy as she takes quite a few meds each day. We had her physicians submit new prescriptions to the mail-order folks who promptly fubar’ed the whole thing by losing the prescriptions & not telling us – eventually my wife started running out of her blood pressure & cholesterol meds. It took us several months to get all the prescriptions restored to the local pharmacy. The worst part was trying to convince BCBS to pay for the replacement prescriptions as they repeatedly claimed that the mail-order prescriptions ‘superseded’ (or something, for lack of a better word) the replacements even though we never received a single shipment from the mail-order folks. For the people getting forced to switch by Anthem, a repeat of my wife’s experiences will likely be a death sentence for them.
They also want you to buy 90 days at a whack, so it makes it even harder on people with fixed incomes.