There is no excuse for health insurers who don’t want to pay for Harvoni, a new cure for deadly hepatitis C. Lawsuits are being filed by patients who refuse to suffer through years of fatigue, chronic pain, cirrhosis, and liver damage before they are given treatment.

UPDATE: Hep C Victims Denied Harvoni Join Class Actions

January 11, 2016 — As Medicaid programs in at least 34 states restrict coverage for Harvoni, a growing number of patients with hepatitis C are being told they are not sick enough for treatment. Click here to read more.

December 2, 2015 — Gilead Science’s pricing strategy for the hepatitis C drug Sovaldi focused on maximizing profits with little regard for accessibility and affordability, according to a Senate Finance Committee investigation. Click here to read more.

November 6, 2015 — Federal officials are warning that state Medicaid programs may be violating the law by restricting access to the hepatitis C drugs Sovaldi and Harvoni to all but the sickest patients. Click here to read more.

August 5, 2015 — Anthem Blue Cross has been hit with a class action lawsuit by a woman with hepatitis C who was denied coverage for Harvoni and Sovaldi. Click here to read more.

July 20, 2015 — Gilead Sciences will stop allowing insured patients to use its price-discounting assistance program for the hepatitis C drugs Sovaldi and Harvoni. Click here to read more.

July 9, 2015 — The FDA has been hit with a federa lawsuit (PDF) in Connecticut filed by two public health groups who are seeking access to raw clinical trial data Gilead Sciences used to gain approval for its hepatitis C drugs Harvoni and Sovaldi. Click here to read more.

June 30, 2015 — Most state Medicaid programs may be placing illegal restrictions on access to new but expensive treatments for hepatitis C, according to a new study. Click here to read more.

June 29, 2015 — Two prisoners in Massachusetts with hepatitis C have filed a lawsuit against the state for failing to provide Harvoni.

What is the problem?

In October 2014, the FDA approved Harvoni, a new cure for hepatitis C made by Gilead Sciences. It is a once-daily pill that can cure over 95% of people with hepatitis C with very few side effects. Unfortunately, Harvoni costs about $1,000 a pill — or about $95,000 for a full 12-week treatment.

Patients With Hepatitis C Demand Cure

Its price is creating serious problems for patients. Health insurance companies, state Medicaid services, and prisons are denying coverage to patients unless they have cirrhosis or fibrosis of the liver.

Patients have been praying for years or even decades for a cure for hepatitis C that does not cause devastating side effects. Unfortunately, now that one is here, they are being told they will have to wait even longer.

Harvoni Lawsuit Filed Against Blue Cross for Denying Insurance Coverage

May 2015 — A lawsuit (PDF) has been filed by a woman whose insurance company declined to cover her prescription for Harvoni, a life-saving cure for hepatitis C, because her disease was not advanced enough.

The woman, Shima Andre, filed the lawsuit against Blue Cross of California (Anthem Blue Cross) in the Superior Court for the County of Los Angeles, Case No. BC582063. According to the complaint:

“Blue Cross told Shima that she would have to live with depression, chronic fatigue, and wait until her liver drastically worsened before it would approve the medication.”

In 2011, Andre was diagnosed with hepatitis C, a contagious liver disease that is transmitted through contact with an infected person’s blood. Until recently, there was no cure for hepatitis C. Over many years, the progressive disease can cause severe liver damage, infections, liver cancer, permanent scarring, and even death.

Andre’s doctor prescribed Harvoni, but Blue Cross denied coverage because it was “not medically necessary.” It might seem like Andre has time to wait, but she wants to have a baby.

She said, “Blue Cross isn’t just interfering with my health; their decision is preventing me from having a child.”

Andre’s doctor appealed the decision three times, but was denied. Blue Cross refused to cover the cost of Harvoni until Andre had at least Stage 3 hepatitis C — advanced fibrosis, which is the first stage of cirrhosis (scarring of the liver).

The lawsuit goes on to state:

“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.”


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