Bob Herman Feb 21
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HIV patients sue CVS over pharmacy networks

A CVS pharmacist works behind the counter.
CVS faces a new lawsuit over its pharmacy networks for HIV/AIDS patients. Photo: RJ Sangosti / The Denver Post via Getty Images

Several HIV/AIDS patients have sued CVS Health, alleging the pharmacy giant flouted federal and state insurance laws by forcing patients into two options: fill their prescriptions at CVS locations or through CVS' mail order, or face thousands of dollars in out-of-pocket costs.

The big picture: It's another lawsuit that raises questions about how people with Aetna health insurance, especially those with expensive chronic conditions, would be treated if CVS got approval to acquire Aetna for $69 billion.

The class-action lawsuit, filed anonymously by patients due to the sensitivity of their conditions, also goes after employers like Amtrak that fund prescription drug plans for their employees and chose to use CVS. The suit boils down to a few key allegations:

  • Patients with a CVS drug plan previously had gone to other local, in-network specialty pharmacies to pick up their HIV/AIDS medications.
  • Patients were shocked to find out their old pharmacy was out-of-network, and they were on the hook for their medications, which could easily cost more than $2,000 a month.
  • CVS changed its pharmacy benefits a few years ago by requiring HIV/AIDS patients to either pick their drugs up at a CVS store or get them delivered to their homes, the suit claims.
  • One plaintiff who is not home several days a week said he found his 90-day mail-ordered supply of drugs "baking in the afternoon sun."
  • Patients also weren't comfortable picking up their drugs because many CVS stores lack private areas to ask questions.
  • The plaintiffs said they also weren't able to opt out of CVS' options.

The major question: Other lawsuits have alleged that CVS uses anticompetitive muscle to force business partners to use certain vendors. Would Aetna customers with conditions like HIV be forced to use CVS and cut ties with their old pharmacies at the risk of paying lots of money for prescriptions out of their pockets?

CVS' response: "We have not been served with this complaint and have not had an opportunity to thoroughly review the allegations. However, (CVS') highest priority is assuring patient access to clinically appropriate drugs while managing overall health care costs for our clients. To that end, we offer our clients multiple clinical tools and pharmacy network options targeted at achieving both of these goals."

Jonathan Swan 4 hours ago
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Bolton bombshell: the clashes to come

John Bolton
John Bolton speaks at CPAC in 2016. Photo: Andrew Harrer / Bloomberg via Getty Images

Sources close to President Trump say he feels John Bolton, hurriedly named last night to replace H.R. McMaster as national security adviser, will finally deliver the foreign policy the president wants — particularly on Iran and North Korea.

Why it matters: We can’t overstate how dramatic a change it is for Trump to replace H.R. McMaster with Bolton, who was U.S. ambassador to the U.N. under President George W. Bush.

Erica Pandey 5 hours ago
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How China became a powerhouse of espionage

Illustration: Sarah Grillo / Axios

As China’s influence spreads to every corner of the globe under President Xi Jinping, so do its spies.

Why it matters: China has the money and the ambition to build a vast foreign intelligence network, including inside the United States. Meanwhile, American intelligence-gathering on China is falling short, Chris Johnson, a former senior China analyst for the CIA who's now at the Center for Strategic and International Studies, tells Axios: "We have to at least live up to [China's] expectations. And we aren't doing that."