Patients combatting HIV/AIDS that are treated with specialty drugs have a new worry: whether their health insurance carrier will limit their ability to obtain prescription drugs from the pharmacy of their choice.
Anthem Blue Cross recently tried to require its beneficiaries who use specialty drugs to obtain them through CuraScript, a mail-order pharmacy owned by Express Scripts, the carrier's pharmacy benefit manager (PBM). If Anthem had implemented this program, patients who prefer to visit their neighborhood drugstores would no longer have had that option.
Because of negative feedback, Anthem Blue Cross decided to reevaluate this change. The insurer could, however, decide to continue with this policy in the near future.
As an activist and advocate for those with HIV/AIDS, as a board member of Shanti, and as a person living with AIDS, I believe any loss of access to community pharmacies through such a policy will harm HIV/AIDS patients. Mail order and community-based pharmacies are not interchangeable. While both dispense prescriptions, only community pharmacies offer face-to-face counseling, monitoring, and other onsite health services that benefit patients.
Great strides have been made in fighting HIV/AIDS through pharmaceuticals. The antiretroviral drugs now available make it possible for patients to live longer, and have a better quality of life, than those contracting the illness years ago. But adhering to an HIV prescription drug regimen can be challenging for patients, and additional support from a trained pharmacist is essential.
Patients often take numerous medications to fight the disease and other, secondary infections. A local pharmacist familiar with their unique health needs can help them get the most from their medications, and ensure that they avoid potentially deadly interactions between highly-potent medications. Just like a trusted physician or therapist, a pharmacist is a key partner in helping HIV/AIDS patients fight the disease.
There are also questions about how quickly patients can access their medications from a mail-order program. Patients using a community-based pharmacy can usually get their medications immediately, unlike those using mail-order warehouses. Waiting for medications to arrive in the mail may put a patient needlessly at risk if the mail is delayed or delivered to the wrong address. For HIV/AIDS patients, missing just a few doses can raise levels of the virus in the body.
Also, people must consider if medicines are lost or stolen or if the doctor's office has lagged on refilling a prescription what will happen. I can always go to my pharmacist, who is part of my health care team and is someone I have depended on for over 12 years. I have a relationship with him. He can provide me with a small amount of medication should anything happen to my meds or if the refill isn't going through smoothly. Mail order can't do those things for me.
I know my neighborhood pharmacist is looking out for me, ensuring that my many doctors' offices, my insurance companies, and my pharmacy are working together so that my 15 daily medications are seamlessly provided for me. I don't trust a faceless mail order company to have my best interests at heart, or the best interests of my fight against my disease.
Anthem Blue Cross claims that its desire to move to it mandatory mail-order policy is a cost cutting maneuver. But the close relationship between the mail-order company and Anthem's PBM (remember, Express Scripts owns CuraScript) shows other possible motivations behind the new policy: increased profit and reduced competition.
California Assemblyman Chris Holden (D-Pasadena) recently introduced AB 299 in the Legislature. AB 299 would outlaw insurance companies from partnering with in-state mail-order pharmacies to force patients to exclusively receive their medications via the mail-order providers. It's expected that the bill will be heard in committee in mid-March.
Those living with HIV/AIDS face difficult health, employment, and social challenges every day. Insurance companies should not further complicate and possibly endanger their lives by restricting where they go for pharmacy care.
And for those tempted to think, "This won't impact me," a word of warning:
If Anthem Blue Cross succeeds in restricting patients' rights and freedom of choice by implementing a mandatory mail order for its most vulnerable, chronically ill patients, isn't it likely they have the same thing in mind for the rest of us?
Chip Supanich is a member of the San Francisco HIV Health Services Planning Council and the Mayor's Disability Council.