The lead plaintiff, Marina Sheynberg, filed the lawsuit in California federal court on July 24 (Case No. 3:15-cv-03417).
In the lawsuit, she accuses Anthem of denying her “medically necessary treatment” because her liver was not damaged enough to justify the $99,000 price-tag on Harvoni. Many other health insurers deny coverage unless a patient has end-stage fibrosis or cirrhosis (scarring) of the liver.
She claims Anthem is in violation of the Employee Retirement Income Security Act (ERISA), according to the lawsuit:
“In violation of ERISA statutes and regulations, Anthem has systematically ignored the treatment recommendations of insureds’ providers and used internal clinical guidelines which are inconsistent with the plain language of insureds’ plans.”
Hepatitis C is a highly-contagious, blood-borne viral disease that causes progressive liver damage. Without treatment, most patients suffer from declining health for years or decades. About 2.7 million Americans and 130 million people worldwide are infected.
Harvoni and Sovaldi are once-daily pills that have been hailed as “miracle drugs” because they cure over 94% of patients within 12 weeks. The only alternatives cure only 70% of patients and cause debilitating side effects like anemia, insomnia, anxiety, depression, and memory loss.