Boston, MAInmates are people too. And they get sick; with a sizeable number infected with hepatitis C. Prison populations are among the most infected, requiring treatment. However, the problems many plaintiffs are having with the inability to access the effective but expensive Harvoni drug are also being felt by those in the penal system. To that end, the Wall Street Journal (WSJ 6/11/15) reports that two inmates have launched a Gilead Hep C Denied Insurance Claim Lawsuit.
Defendants in the proposed class action are Carol Higgins O’Brien, identified as the commissioner of the Massachusetts Department of Correction, and the Massachusetts Partnership for Correctional Healthcare. The latter is a contracted provider of healthcare services for state prisons. The plaintiffs in the Harvoni lawsuit are Emillan Paszko and Jeffrey Fowler.
“Prisoners who ought to receive the new medications are not receiving them, and a vast number of prisoners with Hepatitis C are not being afforded the necessary testing to determine whether they too should receive treatment,” according to the lawsuit, which was filed in federal court in Boston.
The lawsuit is among several Harvoni Denied Insurance Claim Lawsuits emerging over an issue that is as compelling as it is sad. Harvoni and a slightly older companion drug known as Sovaldi - both developed by Gilead Sciences - are highly regarded in the medical community as being the most effective drugs yet in the fight against hepatitis C. The expense, however, is proving to be prohibitive and many healthcare plans and insurers are balking at the cost, delaying approval of treatment or even refusing treatment altogether.
Most insurance providers have a contractual authority to opt for a lesser-expensive alternative provided the alternative is similar - such as a generic - to the prescribed treatment. However, Sovaldi and Harvoni are in a class by themselves. Doctors who prescribe Sovaldi or Harvoni do so given a belief that no other treatment option would be effective.
The WSJ notes that Medicaid programs in most states restricted access to Sovaldi last year, and some prison systems restricted access to newer drugs due to budget constraints. The cost for a 12-week regimen of Sovaldi and Harvoni is described as $84,000 and $94,500 respectively.
Prison systems historically have a high rate of infection. The Harvoni lawsuit takes the prison commissioner and health contractor to task for failure to update their treatment protocols given the availability of new and effective drugs.
“Defendants have not changed their protocol to recognize the new reality in Hepatitis C treatment, and they have done nothing to conduct the necessary pre-treatment testing of the many prisoners - the nonresponders, relapsers, and treatment-naïve - who may benefit from treatment now or in the future,” the lawsuit states.
The two plaintiffs are reported to be quite ill. Paszko, who is located at Shirley, Massachusetts, has serious complications from hep C. His co-plaintiff, situated in a different facility, was reportedly treated with older drugs last year, but the treatment proved unsuccessful.
A federal judge has been petitioned to certify the Harvoni lawsuit as a class action. The case is Paszko et al v. O’Brien et al, Case No. 1:15-cv-12298-NMG, in US District Court, District of Massachusetts.
If you or a loved one have suffered losses in this case, please click the link below and your complaint will be sent to an insurance lawyer who may evaluate your Harvoni Denied Claim claim at no cost or obligation.