Pasadena, CABlue Cross faces a class-action insurance lawsuit alleging the company unfairly denied treatment for hepatitis C to protect profits. According to the lawsuit, which is the most recent of multiple lawsuits filed against the insurer, patients seeking coverage of certain hepatitis C treatments are told the treatment is not medically necessary, despite the serious health effects associated with hepatitis C.
Hepatitis C is a contagious liver disease that can result in the death of the patient. It is contracted by exposure to the blood of a person already infected by the disease. According to court documents, 15,000 people die annually from liver disease linked to hepatitis C, with more than three million Americans living with chronic hepatitis C. Complications of hepatitis C include severe liver damage, infections and liver cancer.
Harvoni and Sovaldi are used to treat hepatitis C. Approved by the FDA in 2014, they reportedly have cure rates around 90 percent, and also generally come with few side effects. For patients with hepatitis C, they’re a miracle drug. The problem, according to lawsuits, is the price. Three months on Harvoni can cost around $99,000 (for more information on Harvoni pricing, read this article by Gordon Gibb).
That, plaintiffs say, is why they’ve had their Harvoni claims denied by Blue Cross, although the company denies claims on the basis that the treatment isn’t medically necessary or that the patient’s liver hasn’t sufficiently deteriorated. In other words, patients who are at risk of liver failure are told they cannot take a drug designed to prevent that liver failure until their livers are much closer to failing.
How often do these denials occur? According to a study published in PLOS One (8/27/15), almost one-quarter of patients who applied for Harvoni treatment are initially denied. Many had the denial overturned on appeal, but going through the appeals process delays the start of treatment, putting patients at risk of serious liver damage.
That’s why patients like Signe Johnson, Shima Andre and Janie Kondell have filed lawsuits against Blue Cross. They say the company is protecting its profits, despite being obligated to cover Harvoni treatment, thereby violating their contractual duties to policyholders. Insurance companies have said the drugs were approved through a process that involved less testing on patients, raising concerns about the drugs’ benefits and side effects.
The Shima Andre lawsuit is Andre v. Blue Cross of California et al., Case No: BC582063, in the Superior Court of the State of California, County of Los Angeles.
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