A class action lawsuit charges that Anthem Blue Cross refuses to cover name-brand medication, even when there is no equivalent generic or the generic is ineffective.
In the suit, K.F. Petty says that in 2007, her doctor prescribed a medication described in the suit as "Drug X" to protect her privacy. There was no generic equivalent for the drug at that time, yet just a few months later, Anthem changed her prescription to a substitute generic that was not pharmaceutically equivalent, Courthouse News Service reports.
Petty says her doctor then began specifying that she should receive the name-brand Drug X but Anthem continued to refuse to cover it.
The suit alleges that Petty's experience is typical and says she is representative of a class of Anthem clients who had to use non-equivalent generics "even when the original prescribed drugs are different and medically necessary for proper treatment."
She charges that Anthem's practice violates California law and has harmed her and thousands of others.
The U.S. Justice Department has gone to court to block Anthem's $54 billion merger with Cigna, charging it would reduce competition and harm consumers. It is also challenging the proposed merger of Aetna and Humana.
Petty is not alone in complaining of Anthem's drug coverage. In a recent ConsumerAffairs review, Janet of Santa Monica said that after switching to Anthem in January, she "quickly discovered that Anthem Blue Cross has by far the most restrictive drug formulary that I have ever encountered."
"I have discovered that five of my medications (three are generics) are considered to be Non-Formulary," Janet said. "Furthermore, my internist went through the Prior Authorization Process for three of my medications and all three requests were denied by Anthem. Now, I have filed three grievances and that process takes at least 30 days. Customer Service has not proven to be helpful in any meaningful way."
Leah of Santa Monica reported a similar experience, saying that "nearly every prescription issued by one of our doctors is rejected, whether brand or generic." She charged that Anthem "makes doctors spend hours fighting with them so their patients can be approved for basic medical care. Usually to no avail."
Anthem has also come under fire for rate hikes and plan changes that critics say are a disservice to consumers. Legislation introduced by Sen. Dianne Feinstein (D-Calif.) and Rep. Jan Schakowsky (D-Ill.) would give the Secretary of Health and Human Services the authority to modify or block premium insurance increases that are considered unreasonable in states, like California, where insurance regulators do not have the power to do so. The bill is in committee.
"Insurance companies answer to Wall Street, not consumers demanding quality healthcare at an affordable price," said Edward Barrera of Consumer Watchdog, a frequent Anthem critic. "Lawmakers need to give regulators a shield to protect consumers, and we believe Sen. Feinstein’s bill will do exactly that.”