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UnitedHealth to lift mail-order requirement for HIV/AIDS meds


By Joanne Finnegan

In a move that could set an industry precedent, UnitedHealthcare settled a national class-action lawsuit by agreeing to allow patients with HIV or AIDS to opt out of a requirement to obtain medications by mail order.

Those patients now can obtain their medications from in-network retail pharmacies, which will help protect their privacy, according to Consumer Watchdog, the nonprofit advocacy organization that brought the lawsuit on behalf of HIV/AIDS patients.

"The settlement with United creates a new national precedent for protecting vulnerable patients subject to mandatory prescription drug mail-order programs," Edith Kallas of Whatley Kallas, LLP, the national law firm that handled the case, said yesterday in an announcement from Consumer Watchdog.

This marks the second time Consumer Watchdog has sued a health insurance company in just as many years. In May 2013, Anthem Blue Cross of California agreed to a similar settlement, allowing patients with HIV/AIDS to obtain medications from pharmacies, instead of its mail-order pharmacy program.

Unlike the Anthem settlement, which was exclusive to California patients, the proposed settlement with UnitedHealthcare applies to the insurer's individual and employer-provided health plans across the country, Consumer Watchdog noted. It also allows patients to exercise their right to opt-out of mail order for a broader range of medications in writing, using the insurer's website or over the phone, according to the settlement agreement.

Under the settlement with United Healthcare, HIV/AIDS patients who are subject to the insurer's mail-order requirement can obtain their HIV/AIDS medications from a pharmacy if they have privacy or delivery concerns, or difficulty discussing their HIV medications over the phone.

"Our members with HIV/AIDS have had, and will continue to have, access to our specialty pharmacy where health outcomes and savings are optimized. In certain instances where our specialty network does not work for a member with HIV/AIDS due to privacy concerns, other options are provided for their HIV/AIDS specialty medications," UnitedHealth said in an emailed statement to FierceHealthPayer.

The list of drugs for which HIC/AIDS patients can opt-out of the mail-order requirement include anemia, growth hormone and neutropenia drugs, in addition to medications used to treat HIV/AIDS. As part of the settlement, class members who paid more for their prescriptions as a result of the mail-order requirement can seek reimbursement for their out-of-pocket costs.

To learn more:
- here's the settlement  (.pdf)
- read the Consumer Watchdog announcement

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