Section 12926.1 of the California Government Code says that "physical and mental disabilities include, but are not limited to, chronic or episodic conditions such as HIV/AIDS, hepatitis, epilepsy, seizure disorder, diabetes, clinical depression, bipolar disorder, multiple sclerosis and heart disease."
Meanwhile, Sections 54 and 55 of the Civil Code state that people with disabilities or medical conditions "have the same right as the general public to the full and free use of the streets, highways, sidewalks, walkways, public buildings (and) medical facilities, including hospitals, clinics and physicians' offices."
As Balto sees it, Anthem's mail-order requirement for people with serious medical conditions, but not for other members, is clearly discriminatory.
"We're talking about these people being forced into mail-order," he said.
Anthem's Ng cited rival Humana as being among insurers that "already require that their members get their specialty medications — including HIV — via delivery in California."
However, Marina Renneke, a Humana spokeswoman, said such requirements are determined by employers offering health benefits, not the insurer.
Green at the Department of Managed Health Care said only that the Knox-Keene Health Care Service Plan Act of 1975, which regulates most managed-care plans in California, doesn't prevent an insurer from using mail-order drugstores for pharmacy benefits.
But with the attorney general opening the door to legal proceedings, it seems likely that Anthem's move will be challenged in the form of either an official investigation or a civil lawsuit.
Anthem is correct to seek lower healthcare costs. A mail-order pharmacy may be more efficient in many cases than a retail drugstore.
But it shouldn't be "my way or the highway," not when people's lives are on the line. Offer a discount for shopping at the pharmacy of Anthem's choosing, but don't punish people for going to the same drugstores that all other members are free to use.
It's unfair. And it may be illegal.
David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send tips or feedback to david.lazarus@latimes.com.
