Doe v. CVS Pharmacy
Doe v. CVS Pharmacy (U.S. Court of Appeals, 9th Circuit, December 9, 2020): The 9th Circuit reinstated a previously dismissed Affordable Care Act (ACA) disability discrimination claim brought by individuals living with HIV/AIDS whose pharmacy benefits manager (CVS Caremark) required them to obtain specialty medications through its designated specialty pharmacy to be considered “in network.” The requirement meant that prescriptions at “in network” prices could only be filled by mail order or drop shipment to a CVS pharmacy for pickup. Plaintiffs argued these requirements deprived them of the ACA’s prescription drug benefit, including medically appropriate dispensing and access to necessary counseling. The 9th Circuit concluded the patients adequately stated a claim for disability discrimination under the ACA, which requires health plans to cover prescription drugs as an “essential health benefit.” Read the decision here.
View all cases in the Judicial Trends in Public Health – March 15, 2021.