Reposted from james321 by Denise Oliver Velez
Aetna is being sued by Consumer Watchdog, a California advocacy group, for discriminating -- likely in pursuit of lower costs and more profits for Wall Street shareholders -- against HIV patients.
A consumer group has sued the health insurer Aetna, claiming that it discriminated against patients with H.I.V. when it required them to obtain medications exclusively through its own mail-order pharmacy.
The lawsuit, filed Friday in federal court in San Diego by the advocacy group Consumer Watchdog, argues that Aetna’s policy violates the new federal health care law, which prohibits insurers from discriminating against people based on medical condition.
The company’s new policy, which takes effect Jan. 1 and applies to people who have purchased individual coverage, also raises the out-of-pocket amount that patients must pay for their treatments, potentially doubling it in some cases, according to the suit.
Mandating mail-order pharmacy use can be incredibly problematic for those individuals -- the poor -- without a reliable address or for those who wish to keep their condition private from roommates or neighbors. (But, for Aetna, requiring the use of its own mail-order pharmacy means more profits for the multi-billion dollar corporation whose CEO earns about $90,000 a day
according to Physicians for a National Health Program
The [federal Health and Human Services] department said that requiring consumers to use mail-order pharmacies could discriminate against people without a fixed address, or those who wished to keep their conditions confidential from neighbors or co-workers who might see the packages. The department has not said whether it will go forward with the proposed rule.
Insurers and pharmacy-benefit managers for years have been prodding consumers with chronic medical conditions to obtain their drugs through mail-order pharmacies.
Besides serving as an added revenue stream, mail-order pharmacies keep down costs as well as premiums, the industry claims. Compared to a neighborhood pharmacy, specialty mail-order pharmacies can also keep better track of the needs of patients with serious medical conditions, the industry says.
Worse, however, than Aetna profiting from inconveniencing HIV patients is the fact that mandating mail-order pharmacy use can, obviously, endanger the health of patients when drugs are inevitably delayed or "lost in the mail." This is particularly dangerous for HIV patients.
But patient advocates say that the restriction of patients to mail-order programs has been particularly onerous for people with H.I.V. Often, they have close relationships with local pharmacists, some of whom specialize in treating people with the virus and are aware of the long list of additional medications that many patients must take.
Refilling medications through the mail breaks that bond, advocates say, and also increases the risk that patients will miss a dose if a refill is not delivered on time. Missing even a small number of doses can lead to a resurgence of the virus.
So, to be clear, Aetna -- and other insurers accused of discrimination in the past -- are certainly aware that missing a dose of an important drug can lead to resurgence of the virus, but they still insist that patients use mailorder pharmacies -- just to send a few more bucks to their shareholders.
But, wait, there's more. Aetna has also -- it appears -- switched HIV patients from paying a co-pay to co-insurance -- leading to dramatically-increased out-of-pocket costs for their drugs.
But the lawsuit asserts that the new policy raises the out-of-pocket costs of the drugs. Previously, Aetna members had to pay $20 to $70 per prescription for H.I.V. drugs. Now they will be asked to pay 20 percent of the cost of the drug, up to $150, the lawsuit said.
Insurers in other states have also been blasted
for discriminating against HIV patients, including an Aetna-owned subsidiary (Coventry) in Florida.
Two groups, the AIDS Institute and the National Health Law Program, filed a complaint on Thursday with the Department of Health and Human Services’ Office for Civil Rights, saying the insurers had violated a provision in the new health care law that prohibits discriminating against consumers because of their medical conditions. They said the insurers had subjected people infected with H.I.V. to restrictions on medications that most patients take daily to keep the virus in check.
“This practice has no rational reason other than to drive people with H.I.V. and AIDS away from their plans,” Wayne Turner, a staff lawyer with the National Health Law Program, said in a conference call with reporters.
The complaint asserts that the four insurers — CoventryOne, Cigna, Humana and Preferred Medical Plan — placed H.I.V. drugs on the highest payment tier for midlevel, or silver, plans on the federal health insurance exchange in Florida.
This discrimination against HIV patients is a uniquely-American perversion of socially-just health care delivery.
In countries like England, France, and Italy -- ones with highly-regulated, government health care systems -- those who face the worst medical problems -- diabetes, HIV, AIDS, Cancer -- actually pay the least for health care. For example, while healthy patients pay minimal co-pays for drugs in England and Italy, those with cancer, HIV or diabetes pay nothing -- ZERO -- for drugs. You know, operating under the assumption that getting really, really sick for a really long time is problematic enough.
We could have that solidarity principle, too, but only if we fire the big-profit insurers -- like Aetna -- and replace them with single-payer, Medicare-for-all.