Re: Blue Cross of California Mail Order Meds scheme quashed

[Guest guest]

A side note.... So we don't all panic at the same time.

Blue Cross Blue Shield is not the same in every state. Most states have their own individual BCBS corporation that contracts services and offers plans of various levels.

If you have Blue Cross Blue Shield as an insurance provider contact the customer service number on your card for information about your specific plan.

- in PHX

PS My insurance is Blue Cross Blue Shield of AZ, with my plan I have the option of retail or mail order. But I saved 1 co-pay every three months ($50/90 day supply mail order vs $25/30 day supply retail) by using mail order. Ironically when I was on meds they were shipped overnight from Tempe, AZ to my office in Phoenix.

Blue Cross of California Mail Order Meds scheme quashed

BLUE CROSS OF CALIFORNIA FORCED TO BACK DOWN ON AIDS MEDS

Activists Demand Public Correction

Last week Blue Cross of California began notifying its members they would no longer be permitted to receive HIV medications from local retail pharmacies but instead were required to utilize an out of state mail order pharmacy. The notification dated July 18 indicated the new requirement was being retroactively implemented effective June 15.

"This would have done enormous harm to people living with HIV/AIDS in California," said Terry Leftgoff, an HIV/AIDS community activist who lives in West Hollywood. "In addition to violating state noticing requirements, this new requirement would have threatened to disrupt treatment regimens and make many AIDS drugs unobtainable by violating the state ADAP program that requires the use of an in-state pharmacy."

In the face of mounting criticism from AIDS activists, government regulators and independent pharmacies throughout California, Blue Cross did a quick reversal today, indicating the notices were sent 'in error' and that HIV/AIDS medications listed on the state ADAP formulary would be exempted from such requirements.

Late last week local pharmacies began reporting that Blue Cross had begun rejecting ordinary refill requests raising the possibility that life saving treatments might be interrupted. "We worked together to educate Blue Cross and are pleased the giant insurer came to understand how such an onerous requirement would endanger their members with HIV/AIDS," said Leftgoff. "We call on Blue Cross to send out correction notices that fully explain the promised exemption to everyone who received the original notices to ensure no treatment is needlessly interrupted. "

Those in the HIV/AIDS community became particularly concerned since such a drastic mandated change at the large insurer would sever a crucial part of the local medical support team upon which those living with HIV/AIDS depend to remain compliant with multiple complicated prescriptions. "It is crucial that patients be allowed to utilize a pharmacist they trust to watch for contraindications and side effects," said Leftgoff . "Forcing people to use a faceless pharmacy located 2,000 miles away in Ohio is utterly foolhardy."

In separate but related news the parent of Blue Cross of California, Wellpoint Inc., the nation's largest health insurer, reported last week that second quarter profit grew 34% to $751.2 million and revenue grew 27% to $14.2 billion.

[Guest guest]

Those insured by Blue Cross of California (Anthem Wellpoint) should have received this page with their updated contract in late February 2006, effective March 1, 2006, which includes this language:

Certain drugs will be obtainable only through Precision Rx Pharmacy Solutions.

http://home.pacbell.net/nstuart/BlueCrossCA.jpg

At the time I found a transcript of an Anthem Wellpoint Conference Call which indicated they wanted to migrate all insureds with Cancer, HIV, and MLS to their in-house Precision Rx Pharmacy. I found two problems with this:

1.) Treating people with these three diseases differently is not legal under the Federal "Americans with Disabilities Act";

2.) The Blue Cross out-of-state pharmacy would not accept payment from the California ADAP program for co-payments.

In early March 2006 my partner contacted Jacques Chambers, an insurance consultant who previously headed up APLA's Insurance Advisory Department. Many of you know Jacques, who is very knowledgeable and well-connected in insurance matters. Jacques led this fight to bring Blue Cross into compliance with applicable laws. For those looking for insurance advice for a small fee, Jacques Chambers can be reached at .

I do not have a copy of the recent Blue Cross letter indicating that they would no longer pay for HIV drugs at the local pharmacy, retroactive back to June 15 (which itself violates California State insurance notification laws). But I'll try to get a copy from an acquaintence who received several - apparantly one letter for each drug that payment would no longer be provided for.

In the future Blue Cross could legally choose to implement a mandatory mail order program for all of their insured, but they have already promised in writing that HIV drugs on the ADAP formulary would be exempt from any such plan.

I was annoyed that it took the Independent Pharmacists Association many months to wake up to this, even though we informed them in March. In California, Blue Cross of California insures 70% of those with medical insurance. Implemented fully, this plan would eliminate more than 50% of pharmacist's business in the state. Fortunately they woke up from their state of denial once payment for one patient after another was cut-off in recent weeks. Its really their fight to lose.

Those with longer memories will recall, about 12 years ago, Blue Cross of California implementing a $25,000 annual cap on home infusions - which would have killed a lot of people with AIDS after a few months. Jacques Chambers, APLA, and many others abruptly killed that plan as well.

You don't have to accept bad treatment from insurance companies or others. Notify your local AIDS Service Organization when you experience a problem or receive notice of a contract change with bad implications. The earlier you can provide notification, the more easily the problem can be addressed.

>> > BLUE CROSS OF CALIFORNIA FORCED TO BACK DOWN ON AIDS MEDS> > Activists Demand Public Correction> > > > Last week Blue Cross of California began notifying its members they> would no longer be permitted to receive HIV medications from local> retail pharmacies but instead were required to utilize an out of state> mail order pharmacy. The notification dated July 18 indicated the new> requirement was being retroactively implemented effective June 15.> > "This would have done enormous harm to people living with HIV/AIDS in> California," said Terry Leftgoff, an HIV/AIDS community activist who> lives in West Hollywood. "In addition to violating state noticing> requirements, this new requirement would have threatened to disrupt> treatment regimens and make many AIDS drugs unobtainable by violating> the state ADAP program that requires the use of an in-state pharmacy."> > In the face of mounting criticism from AIDS activists, government> regulators and independent pharmacies throughout California, Blue Cross> did a quick reversal today, indicating the notices were sent 'in error'> and that HIV/AIDS medications listed on the state ADAP formulary would> be exempted from such requirements.> > Late last week local pharmacies began reporting that Blue Cross had> begun rejecting ordinary refill requests raising the possibility that> life saving treatments might be interrupted. "We worked together to> educate Blue Cross and are pleased the giant insurer came to understand> how such an onerous requirement would endanger their members with> HIV/AIDS," said Leftgoff. "We call on Blue Cross to send out correction> notices that fully explain the promised exemption to everyone who> received the original notices to ensure no treatment is needlessly> interrupted."> > Those in the HIV/AIDS community became particularly concerned since such> a drastic mandated change at the large insurer would sever a crucial> part of the local medical support team upon which those living with> HIV/AIDS depend to remain compliant with multiple complicated> prescriptions. "It is crucial that patients be allowed to utilize a> pharmacist they trust to watch for contraindications and side effects,"> said Leftgoff . "Forcing people to use a faceless pharmacy located 2,000> miles away in Ohio is utterly foolhardy."> > In separate but related news the parent of Blue Cross of California,> Wellpoint Inc., the nation's largest health insurer, reported last week> that second quarter profit grew 34% to $751.2 million and revenue grew> 27% to $14.2 billion.>