Advocacy group Consumer Watchdog has filed a lawsuit against Hartford, Conn.-based health insurer Aetna for discrimination regarding its policy of requiring patients with HIV to obtain medications exclusively through Aetna's mail-order pharmacy, according to a New York Times report.
According to the suit, the health insurer's policy — which would go into effect Jan. 1 — violates federal healthcare law by discriminating against people based on their medical condition.
Additionally, the policy applies to people who have purchased individual coverage and would raise the out-of-pocket amount patients would have to pay for their treatments, potentially doubling it in some cases, according to the report.
In a statement, a spokesperson for Aetna said the policy was consistent with industry standards and is part of the insurer's strategy to keep health plans affordable and medication adherence met. Aetna also claimed members have the option of opting out of the new policy.
Consumer Watchdog, which has settled cases with two other insurers over similar HIV drugs to mail-order program restrictions, claims in the suit that a plaintiff's requests to opt out were turned down by Aetna multiple times.
Other issues regarding the lawsuit and the mail order policy include discrimination against people without a fixed address, breaking the bond HIV patients have with their pharmacists and potentially missing dosages should refills not be mailed on-time.
The mail order issue is also being assessed by HHS, which proposed a rule in the fall to require insurers to offer an alternative to mail-order pharmacies, although members who use local retail pharmacies could face a fee. The department has yet to announce if it will go through with the proposal, according to the report.