Dr. Jaime Vasquez accuses Accredo of recommending a drug that is cheaper but not indicated for treatment of HIV-related symptom
Dr.-Steven-Pounders
Two of Texas’ most experienced AIDS physicians say Blue Cross and Blue Shield of Texas has refused to ship certain specialty medications they ordered to them because the doctors also offer cosmetic treatments.
Specialty medications, including some used in treating HIV and AIDS, often aren’t readily available through neighborhood pharmacies. Because of the costs associated with those drugs, insurance companies control their distribution, sometimes distributing the medications through their own pharmacies.
But spokespeople with Dr. Steven Pounders and Dr. Jaime Vasquez say this system has forced them to refer patients needing some medications to specialists.
Chris Brown, Pounders’ medical assistant, said that two such drugs are Egrifta and Serostim, injectibles that are used in treating the wasting syndrome associated with AIDS. Accredo, Blue Cross’ pharmacy, ships the two medications to physicians for infusion. But the pharmacy won’t ship them to Pounders.
“They’re refusing to ship because [Pounders] does cosmetics as well,” Brown said.
Brown said the two drugs are used to treat conditions related to HIV and side effects of HIV medications. Egrifta treats excess abdominal fat that occurs in some people on HIV medication. Serostim treats AIDS-related wasting. He said patients are prescribed Egrifta until they lose the excess weight, but patients might be prescribed Serostim for the rest of their lives.
But, Brown added, both drugs are also often used in cosmetic procedures that are not medically necessary and therefore not covered by insurance.
Jeanette Grant, who works in the office of Dr. Jaime Vasquez, said Accredo also refuses to ship Serostim to Vasquez’s office because the pharmacy assumes the drug is being used for off-label body-building purposes.
“We had to refer patients out to an endocrinologist,” Grant said.
Both doctors do cosmetic procedures. But both are also well known for their infectious disease practices.
Brown said Accredo also ships Botox, adding that “Blue Cross is blacklisting any doctor who also does dermatology.”
He said this isn’t something that started with the new Affordable Care Act rules that kicked in this year, but last year when Accredo refused to ship the drugs, they found a way around it. This year, they haven’t been able to.
Grant said Blue Cross refused to fill a Serostim order Vasquez’s office place, recommending another drug, Omnitrope, instead. Omnitrope is used to treat anemia, she said, but is not indicated for use with AIDS-related wasting syndrome and no study has been done to show it would be an effective treatment for it.
Brown said last year Blue Cross suggested using the much cheaper appetite-stimulator Marinol, but eventually shipped Serostim when other medications failed. He said Blue Cross even claimed they turned down filling the prescription because they saw on Pounders’ website that he does cosmetic procedure.
At the time, Brown said, his office had no website.
Both Vasquez and Pounders have been treating HIV for years and are considered two of the experts in the field in North Texas. Pounders treated Dallas Buyers Club founder Ron Woodroof. In the 2013 film about Woodroof’s life, titled Dallas Buyers Club, Pounders was portrayed as a female doctor, played by Jennifer Garner.
Blue Cross spokeswoman Margaret Jarvis sent a written statement that said, “Benefit coverage, including for prescription medications, varies among plans,” and directed individuals with questions about their coverage to call the number on the back of their Blue Cross card.
She said Blue Cross and Blue Shield of Texas is committed to providing its members access to “quality, cost effective treatment options/medications” and encouraged patients to “consult with their physicians for the best treatment options.”
“We recognize the opportunities presented by innovations in specialty drugs and other treatments and the value they can bring as we work to improve the health of our members,” Jarvis said. “With input from physicians and researchers, our medical staff constantly reviews the effectiveness of various medications, including Serostim and Omnitrope, to produce the best and most cost-effective outcomes. Both of these prescription medications are covered by BCBSTX.”
While there is no question Omnitrope is cheaper, Jarvis did not address the issue of Accredo recommending the drug when it is not indicated for treatment of AIDS-related wasting. She also did not say whether AIDS physicians who also do cosmetic procedures are flagged and refused specialty medications.
This article appeared in the Dallas Voice print edition July 4, 2014.