Lawsuits have been filed against several health insurance companies for failing to provide coverage for Harvoni, an expensive cure for hepatitis C.

What is Harvoni?

Harvoni is a prescription drug for hepatitis C that made by Gilead Sciences. It contains 400-mg of sofosubir (Sovaldi) and 90-mg of ledipasvir. Studies have shown that it cures more than 90% of patients in as little as eight weeks, with fewer side effects than other hepatitis C drugs.

What is the problem?

The problem with Harvoni is cost. Every pill costs about $1,000 and a 12-week program costs nearly $100,000 in the United States. Insurance companies denying patients’ claims for the drug by saying treatment is not “medically necessary.”

Lawsuits have been filed against Anthem Blue Cross, Blue Cross, and Blue Shield accusing the insurers of acting in “bad faith,” breaching their contractual duty to provide coverage for medical treatment, and boosting profits by denying access to Harvoni.

Harvoni Denied Insurance Claim Lawsuit

In June 2015, the Los Angeles Daily News reported that Anthem Blue Cross was hit with a lawsuit (PDF) filed by a woman who was denied access to Harvoni.

Shima Andre, a 42 year-old who was diagnosed with hepatitis C four years ago, is in the early stages of the disease. Every six months, she must have her viral load checked and endure ultrasounds on her liver. She has a benign tumor on her liver, but the whites of her eyes are changing.

Unfortunately, Anthem Blue Cross says it won’t cover Harvoni until she has reached Stage 3 of severity. By that time, Andre says she will be too weak to work, her liver will have scar tissue and cirrhosis, and she may need to consider having a liver transplant.

The lawsuit states:

“Blue Cross prefers that its insureds get much worse before paying for treatment almost guaranteed to cure their disease. The health of Shima and her family are of no concern to Blue Cross in the face of Blue Cross’s profits.”

The case 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.

What is Hepatitis C?

An estimated 2.7 million Americans have chronic hepatitis C, a liver infection caused by a contagious blood-borne virus. Every year, about 15,000 people die from liver disease linked to hepatitis C.

Complications linked to hepatitis C include:

  • Severe liver damage
  • Infections
  • Liver cancer
  • Internal bleeding
  • Ascites (fluid in the abdomen)
  • Encephalopathy (brain damage)
  • Jaundice (yellowing of the skin and eyes)
  • Chronic fatigue
  • Fever
  • Arthritis
  • Death


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