A new lawsuit filed in California this week alleges that Blue Cross is discriminating against HIV/AIDS patients, among others, forcing patients with certain preexisting conditions to use mail-order only for their pharmacy care.

From the Fox 5 San Diego report:

Under the new program, HIV/AIDS patients’ insurance policies will no longer cover medications at local pharmacies, according to the suit filed Friday by Consumer Watchdog, a nonpartisan consumer advocacy organization with offices in Washington, D.C., and Santa Monica.

HIV/AIDS patients will instead be required to purchase their prescription drugs from a mail order pharmacy, while Blue Cross members who do not suffer from one of the targeted conditions under the same policies will continue to enjoy full access to the pharmacies of their choice, according to the suit.

Health plans and pharmacy benefit managers (PBMs) forcing patients to lose access to their trusted community pharmacist and instead receive medications through the wasteful mail order system deprives these patients of a much needed health care provider.

For patients with chronic illness, their pharmacist is a key player in their ongoing care, and often the provider they speak to the most. For a plan to deny them of that relationship is harmful.

To learn more about how mail-order pharmacies hurt California patients, visit Pharmacy Choice and Access Now today!

Independent pharmacist Odette Leonelli owns a small pharmacy in Redondo Beach. Like many small businesses, the pharmacy has struggled in recent years due to economic hardship, but they have survived. The bigger threat to small pharmacies, according to Leonelli, is not the economy, but the abusive auditing practices of large pharmacy benefit managers (PBMs), the companies who control a large portion of the prescription drug industry in this country, including pricing and pharmacy reimbursement rates.

According to Leonelli’s opinion piece in the Redondo Beach Patch this week:

Small, independent pharmacies like mine have survived many economic downturns-including the Great Recession-and have adapted to technology and the changing needs of our customers. But we face a formidable foe in the large pharmacy benefit management companies (PBMs) that manage prescription drug benefits for more than 215 million Americans. PBMs manage prescription insurance claims, and pharmacies of all sizes must enter into contracts with them in order to serve patients.

Leonelli goes on to describe the frequently unfair PBM auditing process, which has a direct impact on the pharmacy business, particularly smaller, independent pharmacies. Leonelli argues that PBMs use this process to “bully” smaller pharmacies:

Right now, there are no uniform auditing standards, so pharmacies are subject to whatever “rules” a PBM sets up. Because the PBMs keep the money they recover from a denied claim, they have a strong financial incentive to deny every claim.

…

As a result of abusive audits, pharmacies are required to spend excessive amounts of time documenting each pharmacy claim and surviving the audits.  This is time that would be much better spent on patient counseling and care.

So, for relief, we are asking our state legislators to support state Sen. Curren Price’s bill to establish fair standards for pharmacy audits and prevent claims from being denied based on minor technicalities. SB1195 maintains the right of a PBM to audit the claims of pharmacies to identify fraud and invalid prescriptions, but takes away the incentive for the PBMs to deny as many claims as possible. It brings fairness to the audit process.

This legislation is pro-small business, pro-patient, and will not cost taxpayers a dime. It deserves the full support of the Legislature.

To learn more about how PBM’s are hurting California’s independent pharmacies, and find out what you can do to help, please visit Pharmacy Choice and Access Now.