Anne Bucher  |  May 28, 2014

Category: Closed Class Actions

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UnitedHealthcare

UnitedHealthcare Insurance Company, OptumRX Inc., Pacificare Life and Health Insurance Company, UHC of California d/b/a UnitedHealthcare of California and UnitedHealth Group (“United”) have agreed to settle a class action lawsuit with a group of patients who have been prescribed HIV/AIDS specialty treatments. If you are enrolled in or covered by any health plan offered or administered by United and have been prescribed HIV/AIDS specialty medications, your rights may be affected by the proposed class action settlement.

The United class action lawsuit alleged that United’s requirement that members obtain their HIV/AIDS medications on an in-network basis from the Special Pharmacy by mail violated state and federal statutes, regulations and rights of privacy, including ERISA, the Americans with Disabilities Act, and the California Unruh Act.

Due to the complexity of the drug regimen, patients diagnosed with HIV or AIDS rely on local pharmacists who are able to monitor them for adverse side effects and potentially life-threatening drug interactions. HIV/AIDS patients and their loved ones often rely on these pharmacists to help them cope with the challenges of living with the condition. Patients have also expressed privacy concerns associated with the mail-order prescriptions.

United has denied any wrongdoing but has agreed to settle the class action lawsuit to avoid the expense and uncertainty of ongoing litigation. Under the terms of the United HIV settlement, United will allow patients with HIV or AIDS to opt out of a requirement that they obtain their medications by mail order. Class Members who paid more for their prescriptions as a result of the mail-order requirement may also seek reimbursement for their out-of-pocket costs.

Who’s Eligible

Class Members of the United HIV class action settlement include all natural persons who have been diagnosed as having HIV or AIDS and who, as of March 19, 2014, are enrolled in or covered by any health plan offered or administered by United or its affiliates that includes a prescription drug benefit (including but not limited to insured and self-funded ERISA plans, individual plans, governmental plans, and church or group plans), are prescribed HIV/AIDS specialty medications and are required to participate in the program.

Potential Award

Under the terms of the United HIV class action settlement, United has agreed to change its policy to allow patients with HIV or AIDS to opt out of a requirement that they obtain their medications by mail order.

United has also agreed to reimburse Class Members who submit Claim Forms for their valid out-of-pocket costs. If the total amount of valid out-of-pocket costs exceed $240,000, then the amount of reimbursement paid to each Class Member shall be reduced by a pro rata basis.

Proof of Purchase

None required. However, Class Members seeking compensation for out-of-pocket costs must submit receipts or any other records of payment supporting their claims, including but not limited to credit card payment records or evidence of payments made to a pharmacist, along with their Claim Form.

Claim Form Deadline

11/14/2014

Case Name

John Does 1-5 v. UnitedHealthcare Insurance Company, et al., Case No. 8:13-cv-00864-DOC-JPR, in the U.S. District Court for the Central District of California, Southern Division

Final Hearing

7/14/2014

Settlement Website

www.UnitedHIVSettlement.com

Claims Administrator

Doe v. United Settlement Administrator
P.O. Box 43263
Providence, RI 02940-3263
1-866-212-1867

Class Counsel

Edith M. Callas
WHATLEY KALLAS LLP

Jerry Flanagan
CONSUMER WATCHDOG

Defense Counsel

Peter R. Bisio
HOGAN LOVELL US LLP

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One thought on UnitedHealthcare HIV/AIDS Mail-Order Drug Class Action Settlement

  1. Dave Milici says:

    I am relieved to see that there are class action suits pending against UnitedHealthcare and their bogus OptumRx \pharmacy\ service, and would like to learn more.

    The last time my company subscribed with UHC was in 2012, and I could not believe the level of incompetence or lack of professionalism on the part of OptumRx staff fumbling with my medication orders.

    Every month was a repetition of a lengthy phone call to OptumRx to refill the same medication, when some automated refill service or website service would have sufficed, as had been the case with past *real* mail-order pharmacy services. Instead I had to suffer the indignity of talking to some uninformed phone rep, who obviously had no pharmacy experience or training, or even know how to pronounce the medication names. The abysmally terrible customer service and complete lack of attention to pharmacy-related matters at OptumRx seemed like outright misrepresentation to me on UHC’s part.

    Now 2015 my company has switched back to UHC, and now I’m undergoing another round of 800-phone-tag to get my prescriptions authorized at my local CVS pharmacy.

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