Tuesday, September 27

CVS may have violated the ACA by forcing employees to obtain their HIV/AIDS medications through CVS to save money

A federal judge in California ruled that CVS Pharmacy may have violated patients’ privacy rights by forcing them to obtain their HIV/AIDS medicine either by mail order or at a local CVS pharmacy. The judge dismissed CVS’ motion to dismiss.

A CVS Pharmacy in Texas

In the ruling, filed in the Northern District Court of California last week on August 5, 2022, the plaintiffs allege that CVS “have discriminatorily denied them benefits under their employer-offered prescription drug benefit plans. Plaintiffs allege that their benefit plans allow them to obtain their HIV/AIDS medications at favorable “in-network” prices only via mail or a CVS pharmacy”. If the employees wanted to fulfill their prescriptions outside of their employer, they would be forced to pay higher prices since this would no longer be “in-network” CVS was able to require these to be fulfilled “in-network” in part by designating the HIV/AIDS medications as “specialty medications”, which were “subject to specific restrictions” according to court documents.

While the HIV/AIDS medications were not the only drugs categorized as “specialty medications”, the plaintiffs who brought on the lawsuit, HIV/AIDS patients were “disproportionately impacted by the Program,” due to the “complex nature of their disease and medications.”The plaintiffs also alleged that before CVS enrolled them in the program, many of them had already developed long-term relationships with their pharmacists which they claim is critical since these pharmacists know their history and can “detect potentially life-threatening adverse drug interactions and dangerous side effects, some of which may only be detected visually”

CVS fought to have the case dismissed, which was brought against five of their entities, “Caremark, L.L.C., Caremark PCS Health, L.L.C, CVS Pharmacy, Inc., Garfield Beach CVS, L.L.C., and Caremark California Specialty Pharmacy, L.L.C.” but the judge ruled against them since the CVS entities receive federal funding and are subject to the Affordable Care Act.

The case is Johne Doe One, et al., v. CVS Pharmacy, Inc., et al. Case No. is 18-cv-01031-EMC and is filed in the USDC Northern District of California.

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