Updates to our Terms of Use

We are updating our Terms of Use. Please carefully review the updated Terms before proceeding to our website.

Thursday, June 20, 2024 | Back issues
Courthouse News Service Courthouse News Service

Aetna Can’t Dodge Suit Over Mailed HIV Meds

SAN DIEGO (CN) - Portions of a class action filed by HIV and AIDS patients claiming Aetna is trying to force them to receive their medication will move forward, a federal judge has ruled.

U.S. District Judge Larry Burns denied in part and granted in part Aetna's motion to dismiss and denied the plaintiffs' catalyst theory motion for collecting attorney's fees.

John Doe 1 sued the insurance company in December 2014 over changes made to the way HIV/AIDS medication was categorized, requiring patients to receive their medication through the mail rather than the community pharmacy of their choice.

John Does 2 and 3 were added when the first amended complaint was filed.

But in March 2015, the plaintiffs were informed Aetna had suspended the program for employer health plans until January 2016.

The employer-sponsored program was never implemented.

For customers who purchased individual plans, the program was reversed on June 1, 2015. Only one of the three plaintiffs - Doe 3 - purchased an individual plan that was subject to the mail-order program.

Aetna declared it has no current plans to reinstate the program. But the plaintiffs claim the insurance provider will not confirm whether its decision to terminate the program is permanent.

All three plaintiffs claim they requested to opt out of the mail order program, but their initial request was denied.

Contrary to what the plaintiffs claim, Aetna says it would have permitted plan members to opt out of the mail-order program.

Aetna argued the plaintiffs lack standing to pursue relief because the mail-order program was suspended and "there is no credible threat of any future harm." But Burns found in the 8-page order the three plaintiffs had "ample reason to believe" the mail-order program would be put into effect.

"While Aetna's reversal of the mail-order program may present a mootless issue, that issue isn't presented in Aetna's brief and isn't before the court," Burns wrote.

Burns did agree with Aetna that for customers like Does 1 and 2, whose mail-order program for employer-sponsored health plans were never implemented, the two plaintiffs lacked standing to seek damages.

The judge also found the lawsuit meets the ripeness standard, noting "the program wasn't an abstract idea when the relevant complaints were filed."

But while the plaintiffs claimed to have been the "catalysts" in prompting Aetna to abandon the mail program when they filed their lawsuit, Burns found they only vetted the third element in establishing the catalyst theory and "do little to establish the first two elements."

"The court doesn't understand what interest it serves to receive medications at a pharmacy as opposed to through the mail in a presumably nondescript package," Burns wrote.

Since most of plaintiff's claims survive Aetna's motion to dismiss, Burns found, they will be able to establish that they have stated a genuine claim at a later stage.

Consumer Watchdog attorney Jerry Flanagan, representing the plaintiffs, said "egregious threats to privacy and physical and financial health are synonymous with mail order of HIV medications."

He added, "Patients who live in apartment buildings or have medications delivered to their workplace have expressed alarm that neighbors, coworkers and employers, who do not know that the recipient has HIV/AIDS, would come to suspect that they are seriously ill."

Aetna attorney Heather Richardson did not return phone or email requests for comment.

Follow @@BiancaDBruno
Categories / Uncategorized

Subscribe to Closing Arguments

Sign up for new weekly newsletter Closing Arguments to get the latest about ongoing trials, major litigation and hot cases and rulings in courthouses around the U.S. and the world.