Aetna Faces Class Action Over Changes to HIV/AIDS Program

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Aetna Inc. was hit with a class action lawsuit by HIV-positive health insurance policy holders who allege that a new rule the health insurance company plans to implement in 2015 puts their health and privacy at risk.

The unnamed plaintiff John Doe says in the class action lawsuit filed in a California federal court on Dec. 19 Aetna announced a change that is supposed to take effect on Jan. 1, 2015, in which HIV/AIDS will need to purchase “specialty medications to treat HIV/AIDS and other serious illnesses from [Aetna Specialty Pharmacy LLC], a wholly-owned subsidiary of Aetna, Inc.”

This Aetna owned pharmacy only provides prescription drugs through mail-order, which Doe alleges in his Aetna class action lawsuit threatens his health and privacy.

If HIV/AIDS patients opt to purchase their drugs from a local pharmacy “they must pay thousands of dollars or more each month to purchase their medications at their community pharmacy,” Doe claims.

“Under the program, patients using a community pharmacy  will be considered going ‘out-of-network’ and will be subject to ‘non-Network Benefit’ charges under the terms of their health plans,” the Aetna class action lawsuit explains.

However, Doe alleges that even the program is discriminatory against HIV/AIDS patients, which requires them to pay “a 20 percent coinsurance charge of up to a $150 maximum per prescription.”

Before the health insurance plan changes were implemented “program consumers paid a fixed co-pay of $20 to $70 per prescription.”

Doe also alleges in his Aetna HIV/AIDS program class action lawsuit that the program could be potentially life-threatening because while AIDS patients may still purchase some non-specialty medications from a local pharmacy without being penalized, it puts them in the position of having to choose between giving up “essential counseling from an expert pharmacist at a community pharmacy who knows their medical history and who, working directly with patients in face-to-face interactions, is best positioned to detect potentially life-threatening adverse drug interactions and dangerous side effects, immediately provide new drug regimens as their disease progresses, and can provide essential advice and counseling that help HIV/AIDS patients and families navigate the challenges of living with a chronic and often debilitating condition.”

Or, the other option is to “pay thousands of dollars out-of-pocket for their medications at their community pharmacy.”

The plaintiff is seeking to represent a nationwide class of individuals who “are currently enrolled in a health plan provided by Aetna Healthcare, or another Aetna subsidiary, or a health plan in which Aetna is the plan administrator, including an individual plan, government plan, church plan or group plan, that provides prescription drug benefits and have been prescribed specialty medications to treat HIV/AIDS that they must now obtain under the program.”

Aetna sent out a letter in November explaining some changes it is making in January to prescription drug coverage, although it didn’t mention that patients would be “required to solely use a mail-order program to obtain their life-sustaining medications,” adding that the language is deceitful and confusing.

Doe’s Aetna class action lawsuit includes 14 allegations such as violating anti-discrimination provisions of the Affordable Care Act, violating the Employment Retirement Income Security Act (ERISA), a violation of the Americans with Disabilities Act, violations of California business law that prohibits unlawful business acts and practices, breach of the implied covenant of good faith and fair dealing, and California’s Unruh Civil Rights Act.

The Aetna HIV/AIDS program class action lawsuit is asking the California federal court to keep the insurance giant from “implementing the program in its currently proposed form.”

Aetna official Cynthia Michener defended the program and the proposed changes, Law 360 reported.

“As part of our ongoing strategy to do all we can to keep our health plans affordable and help with medication adherence, Aetna moved HIV medications to our specialty drug list. This list includes a number of high-cost medications that treat complex conditions that require close patient monitoring,” Michener said.

The plaintiffs are represented by Edith M. Kallas and Alan M. Mansfield of Whatley Kallas LLP and Jerry Flanagan of Consumer Watchdog.

The Aetna HIV/AIDS Program Class Action Lawsuit is Doe v. Aetna Inc. et al., Case No. 3:14-cv-02986, in the U.S. District Court for the Southern District of California.