Health insurance companies are refusing to pay for the hepatitis C cure Harvoni. Now, patients are filing lawsuits because they refuse to suffer through years of liver damage before they are sick enough to be given treatment.
UPDATE: Hep C Victims Denied Harvoni Join Class Actions
January 11, 2016 — As Medicaid programs in at least 34 states restrict coverage for Harvoni, a growing number of patients with hepatitis C are being told they are not sick enough for treatment. Click here to read more.
December 2, 2015 — The Senate Finance Committee has released a report concluding that Gilead Sciences priced its hepatitis C drugs to maximize profit knowing that patient access and affordability would be compromised. Click here to read more.
November 6, 2015 — State Medicaid programs may be illegally restricting coverage for the hepatitis C drugs Sovaldi and Harvoni to all but the sickest patients, federal officials warn. Click here to read more.
August 5, 2015 — Anthem Blue Cross has been hit with a class action lawsuit by a woman with hepatitis C who was denied coverage for Harvoni and Sovaldi. Click here to read more.
July 20, 2015 — Gilead Sciences will stop allowing insured patients to use its price-discounting assistance program for the hepatitis C drugs Sovaldi and Harvoni. Click here to read more.
July 9, 2015 — The FDA has been hit with a federal lawsuit (PDF) in Connecticut filed by two public health groups who are seeking access to raw clinical trial data Gilead Sciences used to gain approval for its hepatitis C drugs Harvoni and Sovaldi. Click here to read more.
June 30, 2015 — Most state Medicaid programs may be placing illegal restrictions on access to new but expensive treatments for hepatitis C, according to a new study. Click here to read more.
What is the problem?
When Gilead Sciences received FDA-approval for Harvoni in October 2014, it was hailed as a life-saving cure for people with hepatitis C. But with a price-tag topping $99,000 for a 12-week treatment, health insurance companies have balked at covering Harvoni for all but the sickest patients.
Hepatitis C and Harvoni
Hepatitis C is a progressive and often fatal disease. Without treatment, the virus causes liver damage, fibrosis, scarring, cirrhosis, and death in some cases. For years or even decades, patients with hepatitis C suffer from debilitating fatigue, pain, jaundice, and more.
Many patients have prayed for a drug like Harvoni, which is 95-99% effective at curing hepatitis C and has far fewer side effects than other treatments, which cure only 70% of patients. Unfortunately, now that a cure is here, patients are being told they must continue suffering because they are not eligible for treatment.
Blue Cross Hit With Lawsuit For Denying Coverage of Harvoni
Blue Cross of California (Anthem Blue Cross) has been hit with a lawsuit (PDF) by Shima Andre, a woman with hepatitis C who was denied treatment with Harvoni because it was “not medically necessary.” The lawsuit was filed in May 2015 in Los Angeles Superior Court (Case No. BC582063).
According to the lawsuit:
“Blue Cross told Shima that she would have to live with depression, chronic fatigue, and wait until her liver drastically worsened before it would approve the medication.”
Andre was diagnosed with hepatitis C in 2011, but decided not to undergo treatment because her doctor said better drugs would be approved in the next few years. Her doctor was right, but by the time Harvoni was approved in October 2014, her viral load increased steadily and she began experiencing symptoms.
Unfortunately, when her doctor wrote a prescription for Harvoni, Blue Cross declined to provide coverage until she had reached Stage 3 — fibrosis of the liver, a precursor to cirrhosis (permanent scarring). Blue Cross has denied three appeals from her doctor to cover Harvoni.
Andre wants to have a baby, but because hepatitis C can be transmitted from mother to child, she cannot start a family until she is cured. The lawsuit goes on to accuse Blue Cross of putting corporate profits above the health and wellbeing of their customers:
“Blue Cross prefers that its insureds get much worse before paying for treatment almost guaranteed to cure their disease. The health of Shima and her family are of no concern to Blue Cross in the face of Blue Cross’s profits.”