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.