A federal class-action lawsuit has been filed against Anthem Blue Cross over its alleged refusal to cover the costs of a unique hepatitis C drug. The drug, “Havarti,” has been shown to cure 90% of hepatitis C patients after a 12-week course.
The issue comes from how Havarti is, quite simply, extremely expensive. Gilead Sciences, Inc., the company that manufactures the drug, charges around $100,000 for the 12-week series. This places insurance companies in an uncomfortable position. Havarti is a proven drug for a serious condition that insurers are normally required to approve, because there are no similar alternatives available. However, the drug’s price means it is not feasible to grant everyone coverage. The result is that insurers are being restrictive in their approvals, and patients are caught in the middle.
On July 24, Marina Sheynberg sued Anthem Blue Cross for allegedly denying her coverage of Havarti by saying it is “not medically necessary,” as her liver was not sufficiently damaged. This is similar to the claims made in other lawsuits filed against Anthem and other insurers by patients who are frustrated with being denied treatment.
The lawsuits have placed a spotlight on the few, if any, controls the U.S. has on what drug companies can charge for their products. The estimated cost, to Gilead, for each dose of Havarti is around $135.00—not counting the money it spent to acquire the rights to the drug from its developer. Until policy changes or one of the many insurer lawsuits sees its day in court, it is not likely current events will change.
Hepatitis C is a blood-borne infection that targets the liver. It is most common among the baby boomer generation, but often goes undetected as many patients are asymptomatic carriers—meaning they have contracted the disease but display no symptoms, so can spread it to others. Hepatitis C is most often discovered when someone tries to donate blood.
Sources for Today’s Article:
Abram, S., “Woman Sues Anthem Blue Cross for Denying Hepatitis C Drug Harvoni,” Los Angeles Daily News web site, http://www.dailynews.com/health/20150601/woman-sues-anthem-blue-cross-for-denying-hepatitis-c-drug-harvoni, last accessed July 28, 2015.
“Harvoni Class Action Lawsuit,” Class Action Lawsuit Help web site. June 25, 2015, https://www.classactionlawsuithelp.com/harvoni-class-action-lawsuit/.