A 42 year old West Hollywood woman is suing health insurance provider, Anthem Blue Cross, for denying coverage for an expensive, yet life altering drug that would cure her Hepatitis C. The drug in question, Harvoni, was approved by the U.S. Food and Drug Administration just last year, and is very controversial due to its high price tag. Each individual pill costs a little over a thousand dollars, and needs to be taken once a day for twelve weeks, which racks the bill up to almost $100,000 for the treatment. In clinical testing, it has been proven to cure the virus in more than 90% of patients without any significant side effects.
The woman received a denial letter from Anthem stating the drug was not “medically necessary” because she does not have advanced liver damage. “We may approve Harvoni when the liver has a certain amount of scarring on a liver biopsy. Records we received do not show that your liver has this amount of scarring,” Anthem stated in the letter. They still denied coverage even when the doctor who prescribed it lobbied the insurance company to cover the drug. After being diagnosed in 2011, the woman says that she put off becoming pregnant until a drug got approved that would reduce the risk of transferring the virus to her children. “I can’t believe that they demand that a person get sicker before they’ll pay for a cure,” she said. “If there’s a cure for something and you have health insurance, they should cover it.”
The lawsuit accuses Anthem of breach of contract, infliction of emotional distress, and unfair business practices. It also is seeking to be recognized as a class action lawsuit, to make sure others who have been denied coverage can receive the medical care they need. Gilead Sciences, the parent company of Harvoni has come under fire lately, with a lawsuit filed by Philadelphia’s transit agency, accusing it of price gouging. However, the Anthem lawsuit maintains that patients should be covered despite the price. Hepatitis C is a virus that attacks the liver, and is spread by coming in contact with infected blood. It is potentially deadly, but can be stabilized to where the victim can live with it for years.
If you or a loved one have been denied coverage for much needed medical care, the lawyers at Hodes Milman Liebeck are here to help you. Contact us today online at hmlm.com or call (949) 640-8222 for a complimentary case evaluation.