CVS Class Action Says HIV/AIDS Drug Coverage Unlawfully Restricted

CVS Caremark is facing class action claims that its prescription drug coverage improperly forces insured persons to purchase HIV/AIDS medications exclusively from CVS-owned pharmacies.

Four anonymous plaintiffs filed this CVS Caremark class action lawsuit on Friday. The plaintiffs allege an unannounced change in the terms of their prescription drug coverage has effectively barred them from purchasing their expensive and life-saving medications from any pharmacy other than CVS.

The plaintiffs claim that after years of getting their HIV/AIDS drugs from local pharmacies that respected their privacy and with whom they had built good relationships, they are now forced into becoming CVS customers whether they want to or not.

According to the plaintiffs, enrollees in health plans that provide prescription drug coverage through CVS Caremark are told they must get their HIV/AIDS medications through Caremark Specialty Pharmacy, a subsidiary of CVS Health Corp.

Caremark Specialty Pharmacy’s only options for delivery are home delivery via mail order or drop-off delivery at a CVS location. The plaintiffs say these exclusive options threaten their health and privacy.

One plaintiff reports that his HIV/AIDS medications were delivered to his home during the day while he was away, leaving them exposed to hot sunshine that could degrade the medications. Plaintiffs who opted for delivery to a CVS location note that CVS does not have the same comprehensive records of their medication history that their preferred community pharmacies do.

One plaintiff expressed concern about the lack of privacy at CVS locations. The plaintiff notes that CVS prescription drug sales take place very much in the open, where conversations between the patient and pharmacist can easily be overheard. The plaintiff would rather use their preferred community pharmacy, which has an alcove set up to protect customer privacy.

Plaintiffs say their only alternative is to purchase their medications from another pharmacy, potentially paying full price for thousands of dollars’ worth of medications per month.

The new restriction went into effect in 2015 for some plaintiffs and in 2016 for others, according to the CVS Caremark class action lawsuit. Before then, the plaintiffs say they could purchase their HIV/AIDS medications at any in-network pharmacy, with full insurance benefits.

The plaintiffs further allege they were not given proper notice in the change in terms, nor were they given a chance to opt-out. Three plaintiffs say they repeatedly asked to opt out of the CVS Caremark program, but their requests were denied.

The CVS Caremark class action lawsuit also names Amtrak as a defendant. Amtrak employs one of the plaintiffs and is the sponsor for that plaintiff’s health plan. The plaintiffs claim CVS Caremark colludes with plan sponsors like Amtrak to make non-CVS pharmacies “out-of-network” for HIV/AIDS drugs.

The plaintiffs propose to represent all persons previously or currently enrolled in a health plan since Jan. 1, 2015 in which the prescription drug coverage is provided by CVS Caremark, who obtained or may obtain HIV/AIDS medications, and who have been or may in the future be required to participate in the program with no notice and no right to opt-out.

They seek a court order barring CVS Caremark from continuing to implement the plan in its current form. They seek an award of actual, compensatory and statutory damages, equitable monetary relief, and reimbursement of their attorneys’ fees and costs associated with this litigation.

Plaintiffs’ counsel includes attorneys Alan Mansfield and Edith Kallas of Whatley Kallas LLP, and Jerry Flanagan and Benjamin Powell of Consumer Watchdog.

The CVS Caremark HIV/AIDS Medication Restrictions Class Action Lawsuit is John Doe One, et al. v. CVS Health Corp., et al., Case No. 3:18-cv-01031, in the U.S. District Court for the Northern District of California.