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AHF Files Brief Against CVS at the U.S. Supreme Court

9th Circuit Court of Appeals ruled earlier that HIV patients may make a discrimination claim under the Affordable Care Act against CVS for requiring HIV patients to use mail-order pharmacies or to go to a few of CVS’s selected specialty pharmacies, where patients say they are not getting full service

In 2018, AHF warned the U.S. Department of Justice that the then-proposed CVS merger with Aetna would create a monopoly-like behemoth that would harm patients, which appears to be the case here with pharmacy choice

WASHINGTON–(BUSINESS WIRE)–AIDS Healthcare Foundation (AHF), the largest global AIDS organization, filed a brief of amicus curiae with the Supreme Court of the United States earlier today in CVS Pharmacy, Inc. vs. Doe, a case set to be heard and decided by summer 2022.

In December 2020, the U.S. 9th Circuit Court of Appeals ruled in Doe vs. CVS Pharmacy, Inc. that people living with HIV can state a discrimination claim under the Affordable Care Act against CVS Pharmacy, Inc., for requiring them to use mail-order pharmacies to obtain HIV/AIDS medications or to go to one of a few designated “specialty” pharmacies that are little more than pick-up stations, as part of in-network pharmacy services for private insurance plans. CVS appealed the ruling and the Supreme Court agreed to hear the case. In its brief, AHF asks the Supreme Court to affirm the earlier judgement of the Ninth Circuit.

“For people living with HIV/AIDS, real specialty pharmacies and pharmacists that focus on HIV/AIDS and in-person treatment provide demonstrably superior care than do mail-order pharmacies and retail pharmacies. We believe that CVS’s denial of choice in pharmacy services for HIV/AIDS patients is both wrong and discriminatory,” said Jonathan M. Eisenberg, Deputy General Counsel — Litigation for AHF.

AHF’s amicus curiae brief focuses on three primary arguments:

  1. That U.S. Statutory Law Requires Courts to Protect People Living with HIV/AIDS from Disability Discrimination by Healthcare Providers,
  2. That Coerced Use of Mail-Order Pharmacies Is Highly Detrimental to People Living with HIV/AIDS, and
  3. That Coercing People Living with HIV/AIDS to Use Mail-Order Pharmacies Is a Disability-Rights Violation, by Both Intent and Impact.

“CVS said to people living with HIV that they can only go to a few of its selected pharmacies and/or be compelled to utilize its PBM’s mail order pharmacies. Patients asserted they weren’t getting full service there, which discriminated against them. They wanted to keep their current pharmacies which provide more comprehensive and specialty services,” said Tom Myers, Chief of Public Affairs and General Counsel for AHF. “We filed this amicus brief to support HIV/AIDS patients’ legal arguments in the case before the Supreme Court and to defend patients’ rights and choice in their pharmacy services.”

The December 2020 9th Circuit Court ruling validated AHF’s earlier warning of the CVS threat to the HIV response back in 2018. See AHF press statement (Nov. 28, 2018) “CVS-Aetna Merger is Bad for HIV Patients.”

AIDS Healthcare Foundation (AHF), the largest global AIDS organization, currently provides medical care and/or services to over 1.6 million individuals in 45 countries worldwide in the US, Africa, Latin America/Caribbean, the Asia/Pacific Region and Eastern Europe. To learn more about AHF, please visit our website: www.aidshealth.org, find us on Facebook: www.facebook.com/aidshealth and follow us @aidshealthcare.

Contacts

MEDIA CONTACTS:

Jonathan M. Eisenberg, Deputy General Counsel–Litigation for AHF +1.323.860.5361 w Jonathan.esienberg@ahf.org
Ged Kenslea, Senior Director, Communications, AHF +1.323.791.5526 [cell] +.323.308.1833 [work] gedk@aidshealth.org
John Hassell, National Director of Advocacy, AHF +1.202.774.4854 [cell] John.hassell@aidshealth.org

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New Consumer Research Shows 1 in 4 Patients Concerned About Discrimination in Healthcare

Shared Traits Common Between Patients and Providers

PORTLAND, Ore.–(BUSINESS WIRE)–HealthSparq, a healthcare guidance and transparency company, today announced new consumer research on how discrimination shapes healthcare interactions and provider selection. The survey found one in four people are very or extremely concerned about discrimination in healthcare due to their race or the language they speak. These and other survey findings highlight the unique opportunity health plans have to address system inequities by helping patients find providers they trust.

Notable findings include:

  • Nearly half of people who identify as LGBTQ feel they have been discriminated against based on sexual orientation.
  • Among African Americans who have experienced discrimination, 77% feel it was due to their ethnicity or race.
  • Shared traits are extremely common between patients and providers: two-thirds of respondents reported having a doctor of the same gender. Shared race is also frequent.
  • When selecting providers, location and gender are more important when it comes to choosing a PCP, while specialization, experience, affiliation, and education/training are more important when choosing a specialist.

Discrimination not only impacts the care people seek, but being discriminated against drives them to take action. When faced with discrimination, 61% report switching providers, 21% discuss the discrimination with someone else at the provider’s office, and 7% change insurance coverage.

“Both data and personal stories continue to underscore that healthcare isn’t equitable in this country. Factors such as race, income, and zip code result in lower quality healthcare and outcomes,” said Mark Menton, General Manager of HealthSparq. “With this survey, we wanted to find out what’s most important for people in historically underrepresented groups as they navigate healthcare and choose providers. We found that people often seek providers they share traits with, like common language, gender and race. In fact, shared traits seem to be a powerful indicator of the patient-provider relationship. About half of consumers feel that having shared traits with their healthcare providers assures better care and more open discussion.”

The survey revealed what people look for when selecting care, which coupled with findings related to discrimination, present an opportunity to help connect patients with the providers they want most. In addition to shared traits, respondents reported a variety of characteristics important when researching providers or selecting a new provider, with quality of care at the top of the list, followed by education, ratings/reviews, specialization in age/condition, and treatment philosophy.

Six in ten respondents report using their health insurance plan’s website to gather information on providers, which underscores the important role health plans have in facilitating trusting relationships between patients and providers. By offering more robust provider information in their online directories, health plans can enable individuals to self-select a provider who they share traits with and can trust. While sharing more detailed provider information will not solve decades of unequal access to care and discrimination, it is one step in the right direction to improving access and outcomes.

To download the full report, visit: https://bit.ly/ProviderLikeMe

About HealthSparq

At HealthSparq, we help people make smarter healthcare choices by partnering with health plans to share cost and quality information about doctors, hospitals, medical services, and medications. Serving more than 80 million members across the country, we put people at the core of everything we do by conducting continuous usability testing, turning consumer research into product innovations, hosting industry panels featuring everyday people, and bringing human stories to the forefront through our #WTFix campaign. Using these insights, we create solutions to help people understand and navigate the healthcare system better than ever before.

Born inside a health plan in Portland, OR, we’ve been growing since our 2012 corporate founding. In 2021, we became part of Kyruus, the leader in provider search and scheduling solutions for health systems, to pursue a shared vision of connecting people to the right care. Contact us at HealthSparq.com or tweet us @HealthSparq.

Contacts

Kara McCrudden

Aria Marketing for HealthSparq

401-474-3308

kmccrudden@ariamarketing.com