Lawsuit Settlement Spells End of Insurers’ HIV Drugs-by-Mail Mandate

United Healthcare and Consumer Watchdog yesterday settled a lawsuit over an insurance company mandate that HIV and AIDS patient needed to receive their prescription medication through a mail-order service.

Under rules of the settlement, mail-order medication will be an optional program. Patients can choose to opt out if they have concerns about privacy or delivery, or if they aren’t able to discuss their medication interactions and other pharmaceutical concerns over the phone. 

“I’ve been doing this kind of work for 20 years now and this is most I’ve heard from people who are absolutely panicked,” said Jerry Flanagan, lead staff attorney at Consumer Watchdog, a not-for-profit legal advocacy group based in Santa Monica. “These drugs are life-saving, and they’re available — but you can only get them by jumping through these fiery hoops,” Flanagan said.

There are many complications from shipping sensitive and expensive drugs through the mail, Flanagan said. They can get lost or stolen, they can sit too long in a hot mailbox, they can be delivered late. “That just doesn’t work for these patients,” Flanagan said. “If you miss a dose of these drugs, or even delay it for a couple of days, it can have cataclysmic effects.”

“United should be commended for listening to the serious and heartfelt concerns of their customers who depend on local pharmacists for their life-saving medications,” said a written statement from United attorney Edith Kallas of Whatley Kallas, LLP, based in Birmingham, Alabama.

“The settlement with United creates a new national precedent for protecting vulnerable patients subject to mandatory prescription drug mail-order programs,” Kallas said.

That precedent includes patients outside of the settlement who need to receive their cancer or transplant medications through mail-order companies, Flanagan said.  

“This is on behalf of HIV patients, but it sets a precedent for a number of chronically ill patients,” Flanagan said.

Patients can still get medications by mail, but since it’s optional rather than mandatory it’s possible that insurers might offer an incentive to chronically ill patients to participate in the program, Flanagan said.

“Insurance companies make money by promising pharmaceutical mail-order companies a certain volume so they can guarantee profits,” Flanagan said. “Now insurance companies have gotten the message that they can’t do so in a way that threatens people’s health.”

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