Monday, November 16, 2015

Aetna: Mail Order Pharmacy (2014)

Aetna Company logo

Aetna may be a Fortune 100 company, but it is unlikely to see a little to no controversy with a company this large and advanced. In 2014, the consumer advocacy group, Consumer Watchdog, filed a class-action lawsuit against Aetna Inc. for discrepancy related to Aetna’s new policy regarding mail-order pharmacy. The advocates for this particular group rightfully defend their beliefs that this new policy discriminates against the privacy of individuals diagnosed with HIV and AIDS by requiring them to get their medications through Aetna’s mail-order pharmacy. Sending drugs through the mail is a risky establishment to begin with because packages may have the wrong address and the mail system is not one hundred percent reliable. Packages arriving a few days late or not arriving at all puts the patient at a detrimental risk to their health because dosages for these patients who are diagnosed with HIV or AIDS need to be taken in a timely manner.
The plaintiff challenged the company in court for months and finally was allowed to continue receiving medication at his local pharmacy for the same rate with no upcharge. The Affordable Care Act is supposed to work towards ending discrimination against patients based on their medical and health conditions and this argument that the plaintiff made stays relevant. He makes a plausible case that giving the patient an option to use their local pharmacy in replacement of the offered mail-order pharmacy means close to nothing if the patient is charged extortionate and almost unaffordable amounts to do so. Consumer Watchdog targeted Anthem Blue Cross as well. Anthem Blue Cross was targeted a year earlier in 2013 by leaving their most vulnerable patients with no option but to opt in for the service. Patients must rely on these drugs to be delivered on time in order to monitor their bodies. By cutting out the interaction that patients make with the pharmacist, other benefits are also being taken out due to this.

Consumer Watchdog files class-action lawsuit against Aetna

The stakeholders in the Consumer Watchdog vs. Aetna case include the patients, patient’s families, employees, employers, and the company hired to deliver the medications. Patients with HIV/AIDS who have Aetna health insurance are the individuals that are going to be impacted the most in this situation because they must receive their medication in a timely manner. Receiving their medication in a timely manner is a must so they can monitor their health while avoiding unaffordable costs due to restrictions placed on local pharmacies if possible. Patient’s families are affected and the amount of negative impact might depend on the relationship the patient has with a family member. The employers are hiring individuals to represent their company policies and it is the employer’s responsibility to maintain a positive image for the company. The mail-order service is responsible for delivering the package in a timely and safe manner to ensure the patient’s medications are in tact. Individuals considering whether or not to sign up for a plan with Aetna or another Health Insurance provider that have HIV/AIDS are also being impacted because they have to review the benefits of signing an agreement. Each stakeholder is concerned the end in mind and ideally strive to benefit from involvement.

“The only goal of business is to profit, so the only obligation that the business person has is to maximize profit for the owner or the stakeholders.” Milton Friedman
Milton Friedman was an economist and Nobel Prize Winner for Economics (1912-2006). Friedman’s theory obliterates the meaningfulness of the identity of the company and the motivation of investors to invest in a socially responsible business as well as responsible customer and employee interaction. Stakeholders are not being considered in this theory because if we are only focusing on profiting the business does not rightfully take a closer look at those being negatively impacted. Analyzing the Consumer Watchdog v. Aetna from the individualistic theory, individualists would say that Aetna was ethical considering the main motive of a profit. Under the individualistic theory, vulnerable patients who were being put at risk of receiving their medication late were not being treated fairly because they would have to pay upwards of a thousand dollars to receive the same medication that they would be receiving from a mail-order pharmacy. In retrospect Aetna is putting restriction on top of restriction so that it is harder for patients to receive their medication, which is why they are gaining a profit, and holding their customers.

Comparatively to the individualist approach, Utilitarianism takes into account the opinions of stakeholders. “Happiness or pleasures are the only things of intrinsic value”. John Stuart Mill (1806-1873) popularized this theory and considered that those who are capable of feeling happiness or pleasure must do so impartially. Principally utilitarianism considers the costs and benefits of the actions being taken and looks at all stakeholders affected to reduce pain and risk to reach an ultimatum which is described as a happiness or pleasurable state. Aetna is not fulfilling the Utilitarianism take on the mail-order controversy because they are not producing the maximum happiness they can for others. Under a utilitarian structure, the individuals would be considered having gained happiness as a pleasure or freedom but it would be limited. The downside to obtaining this agreement would be that an individual with HIV or AIDS would have to risk their health even more so by agreeing to a mail-order form of medication delivery. This is not maximizing user happiness or pleasure. In fact, this is preventing a state of contentment, which would be considered unethical.

Aetna head quarters in Hartford, CT

The Kantianism theory derived from Immanuel Kant, an economist, who focused his theories on the rationales and Good Will of humanity. There are four basic principles of Kantianism. They are to act rationally and to not act inconsistently in your own actions or consider yourself exempt from rules, to allow and help people to make rational decisions, to respect people, their autonomy, and individual needs and differences defines, and one should be motivated by Good Will, by choosing to do what is right because it is the right thing to do. To be rational is to do the right thing. Knowing that you have done the correct thing means that you have abstained from impermissible actions and have done what is morally permissible or morally required. Kantians would believe that Aetna was making the wrong choice and permissibly cheating their patients with HIV or AIDS. Aetna has the right moral motivation by providing at least one option (mail order pharmacy) to their patients, but are not appreciating the patients who cannot afford to pay upwards of a thousand dollars for medications.

Virtue TheoryVirtue theory appreciates a person’s character. The characteristics that allow things to function properly are called ‘good-making features’ or ‘virtues’. These virtues depend upon the thing’s function and the thing’s circumstances. There are four main virtues of character: courage, honesty, temperance/self control, and justice/fairness. An Ancient Greek philosopher, Aristotle, first developed the Virtue Theory even though there were other differentiating theories that philosophers discussed over time. Analyzing from the virtue theory, Aetna did not accomplish all virtues. Aetna was not being rightfully courageous because representatives were not vouching for the patients who opposed to mail-order medications. Honesty was applied in this situation because Aetna was being honest with their policy to only provide mail-order medications with no upcharge. Justice and fairness was not applied to Aetna’s new-implemented policy. Patients were being shorted their option to receive medications from a local pharmacy because it was not being covered by Aetna.

Justified Ethics EvaluationThe primary concern of the advocacy group who filed a class action lawsuit against Aetna was the alleged discrimination against patients with HIV or AIDS that puts their privacy and health at risk. As a result, Aetna moved the HIV medication into the category of specialty drugs where the patients have access to a specialty health care management program to support patients and keep them on track. The Affordable Care Act provides Americans with a better safekeeping for health that increases coverage, holds insurance companies responsible, lowers health care costs, guarantees more choice, and enhances the quality of care for all Americans. Part 1 Title 1 section 2704 of the Affordable Care Act states that “No group health plan or insurer offering group or individual coverage may impose any pre-existing condition exclusion or discriminate against those who have been sick in the past”. Along with other statements in Part 1 Title 1 of the Affordable Care Act, there are various rule applied to health insurance companies that protect against discrimination. As we know, not every law is followed and there are roundabouts to what rules mean. If I were a patient that was restricted to mail order medications I would feel like my privacy and benefits were being restricted and in my opinion this would be unethical to limit my risk of pain. I would have to agree that the advocacy group Consumer Watchdog did the right thing by claiming that Aetna was discriminating against those who, one, have HIV or Aids, and second, would like to receive or pick their medications up from a local pharmacy. As an individual that does not have first hand experience with a severe medical condition, my knowledge on living with one is little to none. I do send my medications to a local pharmacy and have taken advantage of advice that pharmacists are authorized to provide and if I was charged exuberant amounts for retaining valuable information about dosages and professional medical advising on my medical health I would feel violated. I adhere to the Utilitarianism approach as well as the Kantianism approach. It is important for my morals to consider the stakeholders in a situation and to do the right thing because it is the right thing to do.

"Aetna History." – About Us. Aetna Inc., n.d. Web. 21 Oct. 2015.

Coren, Courtney. (2014, December 26). Aetna Faces Class Action Over Changes to HIV/AIDS Program. Top Class Actions: Top Class Actions LLC.

PR, N. (2013, June 11). Consumer Watchdog: United Healthcare Sued for Discriminating Against HIV/AIDS Patients. PR Newswire US.

Salazar, Heather. The Business Ethics Case Manual: The Authoritative Step-by-Step Guide to Understanding and Improving the Ethics of Any Business. Print.

Thomas, K. (2014, December 23). H.I.V. Drugs Are Target Of Aetna Suit. New York Times. p. B1.

Watson, Julie. Associated, P. (2014, December 23). Consumer group sues Aetna, alleges discrimination. Associated Press State Wire: California (CA).

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