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Anthem move may affect HIV treatments

By Aaron Blevins, 1/03/2013

Requiring HIV/AIDS medications to be mailed causes concern

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Local pharmacies and HIV patients fear that a policy change by Anthem Blue Cross could lead to delays in patients receiving their medication, preventing them from taking their daily medications on time.

Some believe relying on the U.S. Postal Service to deliver HIV/AIDS medication could put patients at risk. (photo courtesy of Getty Images)

According to the California Pharmacists Association, Anthem’s new policy, which would require its HIV patients in Southern California to receive their medications through mail order beginning in March, could affect patients’ HIV treatment.

“We’re dealing with a very aggressive disease state with these patients,” the association’s CEO, Jon Roth, said.

Missing a dose of their medications could lead to patients building a resistance to the drugs, he said. Therefore, Anthem’s requirement that medications be sent through the mail raises many issues, though it could be more cost-effective, Roth said.

“Their health outcomes are going to suffer,” he said, adding that he wasn’t privy to how much the insurance company could save. “We would never put price above healthy patients.”

Furthermore, a patient’s rapport with his or her pharmacist is a key to good outcomes, said Jimmy Vesci, a pharmacist at Capitol Drugs in West Hollywood. He added that patients are more likely to ask personal questions of their pharmacist, as opposed to an automated service, which Anthem has proposed.

Vesci said the policy change affects mostly HIV patients. He said his patients do not want to rely on the U.S. Postal Service for something so critical, as missed doses could lead to the virus mutating. It could also lead to patients building a resistance to the medication and other HIV medications on the market.

“This is not blood pressure or cholesterol you’re dealing with,” Vesci said. “It’s a live virus.”

The policy change is also detrimental to Capitol Drugs, CEO Ruth Tittle said. She said the move will prevent the company’s pharmacists from taking care of patients, some of whom had been going to the pharmacy since they were diagnosed.

“All of these people are part of their healthcare team,” Tittle said. “We know them. There’s a lot more to taking care of patients than knowing what drugs they’re on. It’s about knowing the patient.”

She said the pharmacy’s staff knows their patients’ medical history, psychological and social status, caregivers and significant others. Tittle said the relationship between the pharmacy and its patients can be crucial, especially if the individual is having mental issues, such as depression.

“If the patient is going through some emotional situation, they may not be inclined to think about taking their medications,” she added. “Every dose is so important, because this virus is very smart. …This is frightening.”

Anthem had planned for the policy change to take effect on Jan. 1, but at the request of the Department of Managed Health Care and other advocacy groups, its implementation was delayed until March.

Anthem has created a process for patients to request a hardship waiver in order to opt out of the new policy, but Tittle said one of her patients was denied, though the insurance company didn’t specify why or whether there was an appeals process.

According to Anthem, patients will be provided access to a nursing program to help them stick to their regimes and avoid side effects. Patients will also have constant access to a registered nurse or pharmacist over the phone.

“Purchasing expensive specialty prescription drugs in bulk for home delivery benefits our members by saving them money, and evidence-based studies have shown that home delivery is correlated with an increased likelihood of patients taking their medicine as prescribed,” Anthem public relations director Darrel Ng said.

He cited two studies that stated that mail order medications lead to better drug adherence and better outcomes. Ng didn’t specify how the prescriptions would be shipped, and wasn’t aware of any patients’ opt-out requests being denied. He cited the aforementioned studies when asked about the possibility of lost or stolen shipments.

Ng said California is in the last wave of states to implement the policy change. Roth, of the pharmacists association, said that as far as he knows, Anthem is the only insurance company to implement this policy. He said its studies are suspect.

“The statistics are very misleading,” Roth said, adding that some insurance companies consider “drug adherence” to mean that the medications have been placed in the mail. “In my opinion, it’s really smoke and mirrors.”

He said the association has been asking its members to reach out to Anthem and express their concerns with the policy change. The association is also looking at possible legislative options to ensure that patients can get their medications from their pharmacists.

 

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