Pressure is growing on insurers to stop using mail-order pharmacies for speciality medications, and also on benefits managers to find new ways to get lower drug prices.
Barely half-a-year after starting a mail-order requirements for HIV/AIDS drugs, the Blue Cross and Blue Shield federal employees program is phasing it out at the end of June, after complaints by the group Consumer Watchdog.
Thirty-three HIV/AIDS drugs, including Aptivus, Retrovir and Viramune, will be moved off the speciality drug list and made available through a network of preferred retail pharmacies, while remaining in tiers for generics or preferred drugs, the Blue Cross and Blue Shield Association said in a letter to federal employee members.
Patient advocates have criticized mail-order programs that include speciality drugs like HIV/AIDS -- and insurers have made changes.
In March, UnitedHealth let those getting HIV/AIDS drugs opt-out of mail-order, following a similar decision by WellPoint's Anthem Blue Cross last June, after complaints from Consumer Watchdog.
Jerry Flanagan, the group's lead attorney, said the mail-order access program can be "nerve-racking" for individuals with HIV or AIDS. Many HIV or AIDS patients have become acquainted to getting medications from community pharmacists and seeking their advice, and some can feel that their privacy is being violated, if medications are being left outside of apartments or delivered to a workplace, Flanagan said.
In January, BCBS's federal employee plan introduced the mail-order requirement for HIV/AIDS drugs, using CVS Caremark as the pharmacy benefits administrator, along with a new tiered cost-sharing system.
The first tier for generics has up to a $30 co-pay for each 90-day supply, while the second, for preferred drugs, costs up to $135 per 90 days.