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Harvoni Denied Insurance Claim Lawsuit
Were you looking for Blue Cross Facing Lawsuit over Denying Gilead Hep C Drug Coverage lawsuits?
By Heidi Turner
Consumers are filing lawsuits against insurers who deny them access to Harvoni treatment, alleging the drug should be covered by their insurance. Among the insurance companies that currently face Harvoni lawsuits—or those who could potentially face them—are Anthem Blue Cross, Florida Blue Cross and United Healthcare.
Harvoni, sold by Gilead Sciences, is a hepatitis C treatment. Hepatitis C is a contagious, potentially fatal, liver disease that is contracted through exposure to the blood of a person infected with it. Complications linked to hepatitis C include severe liver damage, infections, and liver cancer. Patients with hepatitis C can also experience other adverse health effects, including fatigue, pain, fever and arthritis.
According to court documents, more than three million people in the US have chronic hepatitis C, with 15,000 people dying annually of liver disease linked to hepatitis C.
In October 2014, the FDA approved Harvoni to treat hepatitis C. According to reports, Harvoni cures more than 90 percent of patients infected with hepatitis C in as little as eight weeks and with few side effects. Of concern is the cost—Harvoni costs around $99,000 for a 12-week program, according to documents filed in a lawsuit.
Insurance companies are accused of setting restrictions on the hepatitis C patients who are approved for Harvoni treatment. Plaintiffs allege they have had their Harvoni claims denied on the grounds that it is not "medically necessary."
According to documents filed in one lawsuit against Anthem Blue Cross, the plaintiff was denied Harvoni treatment on the grounds that her liver was not damaged enough to warrant treatment. In other words, the plaintiff' liver had to have significant enough damage to warrant treatment, even though the treatment is designed to prevent liver damage and despite the plaintiff's doctor writing repeated letters on her behalf.
Lawsuits filed against insurers like Anthem Blue Cross and Blue Cross and Blue Shield of Florida allege the insurers breached their contractual duty to provide coverage for medically necessary treatment. They further allege breach of good faith and negligent infliction of emotional distress. Lawsuits filed in California also allege insurers deny treatment to increase profits, a violation of California law.
Insurers have defended their decisions, saying Harvoni was approved through a process that meant it was tested in fewer people, raising concerns about the benefits and side effects associated with the drugs.
Some policyholders may have their claim preempted by ERISA (Employee Retirement Income Security Act). Policyholders who aren't likely to have a preempted claim are those who have insurance through an employer who is the government, a church or other religious entity, or who have their own self-insured policy—that is not through an employer, Medicare, Medicaid or the VA.
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Harvoni
Harvoni, sold by Gilead Sciences, is a hepatitis C treatment. Hepatitis C is a contagious, potentially fatal, liver disease that is contracted through exposure to the blood of a person infected with it. Complications linked to hepatitis C include severe liver damage, infections, and liver cancer. Patients with hepatitis C can also experience other adverse health effects, including fatigue, pain, fever and arthritis. According to court documents, more than three million people in the US have chronic hepatitis C, with 15,000 people dying annually of liver disease linked to hepatitis C.
In October 2014, the FDA approved Harvoni to treat hepatitis C. According to reports, Harvoni cures more than 90 percent of patients infected with hepatitis C in as little as eight weeks and with few side effects. Of concern is the cost—Harvoni costs around $99,000 for a 12-week program, according to documents filed in a lawsuit.
Harvoni Denials
Insurance companies are accused of setting restrictions on the hepatitis C patients who are approved for Harvoni treatment. Plaintiffs allege they have had their Harvoni claims denied on the grounds that it is not "medically necessary."According to documents filed in one lawsuit against Anthem Blue Cross, the plaintiff was denied Harvoni treatment on the grounds that her liver was not damaged enough to warrant treatment. In other words, the plaintiff' liver had to have significant enough damage to warrant treatment, even though the treatment is designed to prevent liver damage and despite the plaintiff's doctor writing repeated letters on her behalf.
Harvoni Insurance Lawsuits
Insurers have defended their decisions, saying Harvoni was approved through a process that meant it was tested in fewer people, raising concerns about the benefits and side effects associated with the drugs.
Harvoni Insurance Claim
Harvoni Denied Insurance Claim Legal Help
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HARVONI DENIED CLAIM LEGAL ARTICLES AND INTERVIEWS
Medicaid Patients Denied Harvoni Treatment
The Predatory Pricing Policy of Harvoni as a Modern-Day Scrooge
Debunking Harvoni Pricing
January 22, 2016
Indianapolis, IN: Although most of the news regarding denied Harvoni insurance claims and resulting lawsuits involves private insurance providers, it appears Medicaid is also denying patients necessary Harvoni treatment. Patients allege Medicaid and other insurance providers are playing with their lives by deeming the hepatitis C treatment not medically necessary. READ MORE
The Predatory Pricing Policy of Harvoni as a Modern-Day Scrooge
December 26, 2015
Washington, DC: In the wake of a congressional inquiry into prices and pricing strategy inherent with hepatitis blockbuster drugs Harvoni and Sovaldi, comes damning insight into the workings of a manufacturer pricing a drug through the stratosphere - its expectations for a backlash and its plan for damage control. The revelation should provide added fodder for plaintiffs and their attorneys embroiled in Harvoni Lawsuits. READ MORE
Debunking Harvoni Pricing
November 24, 2015
Washington, DC: While most Harvoni Denied Insurance Claim Lawsuits take issue with insurance companies that balk at approving Harvoni treatment for hepatitis C in spite of medical need, one must only look at the pricing strategy maintained by Harvoni manufacturer Gilead for clues that could lead to another smoking gun. READ MORE
READ MORE Insurance Settlements and Legal News
READER COMMENTS
Josephine Lamont
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He wasn't informed that there had been cases of people developing liver Cancer after receiving treatment. I think people deserve the right to know if there's any controversy about possible side effects.
He died of Liver Cancer August 20th 2018. 13 days after the doctor told my brother he had up to 6 months to live. He went very fast and didn't have a chance at beating the cancer. I also think the doctors lied to him and didn't tell him he had cancer earlier until it was to late. Be careful when it comes to doctors cause medical error is one of the leading causes of human death.
Worried wife
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Donna Hunnicutt
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CKN, RN
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Richard
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ricky michaels
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Donald Webner
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Melissa
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Eric Rotmil
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That as of Jan 2016 some Anthem and United Health Care
states are not denying due to the not sick enough thing anymore. Can't find this published, but a Gilead Rep told me that.
FloridaBlue is one of the hold outs that won't change their definition of "medical necessity" concerning patients.
I have requested the criteria they used to deny my claim.
(they use comparative research from who knows where and who knows what)
also getting tested for EHMs I am feeling tired and sick last two years, did not realize HEP C can cause many other health issues, speaking to lawyers too.
won't say much about that, just wanted to make some aware that things are changing , probably by 2017 all will be covered for Harvoni. Lets hope.
donald webner
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Mia Wood
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In the process of waiting for treatment even though the dr knerlw I had verisies sto.ACH ulsers herniea history of mostly alcohol abuse and mental illness I was not educated about my disease I ended I end up with five blood transfusions in five months the hospital called my family in. I was dieing didn't know it. Today my specialist won't prescribe preventive medicine because my M.D. did id y specialists would have educatede and kept a closer eye on me I wouldn't be dieing at this time I don't drink alcohol but after three clean urine test he didn't prescribe Hep med cause I got one dirty am I not worthy of medication because of something I've been dealing with since I was a baby I was expected to Die at 3yrs with phenomena in 1963. My mental health issues Ive been dealing with all my life there is now the the chance of dieing of hep c. I pray God isn't done with me yet.
TESS
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Michelle Diaz
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Melissa
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Holly Heuer
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Jan
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Mary Beth
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Michael Wood
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Monica
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Venetia Kelley
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Boing66
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Barb Terry
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playing GOD by the insurance companies (who gets treatment and who does not) for the sake of their bottom line is actually understandable because it will bankrupt them to treat everyone right off the bat. But the pharmaceutical companies are disgusting for charging $1000.00 per pill !
How can anyone deny life for profit?
(Pro-life???)
Beth Haemingway
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PDMac
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I have Geno 3;F4 ; but they want me to take a drug that will damage my liver even more and probably keep my from holding a job that pays for my insurance.And the when your not naive and have failed your first treatment its even harder to get treated again. Do you know that Pharassist that developed this drug was supported through federal grants and the head at the time was a VA doctor on the government payroll; then Gillead bought them out ; never had any R&D money in it and just overcharged as much as they could; In India you can treated for under $2000.00 total; its not that hard; look up Greg Jefferys.
Alan J Lewis
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Bella
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oscar
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Jan
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TC Chatman
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Jan Scott
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Beth Hemingway
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denise shepard
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Kris Edwards
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I work in a healthcare setting where we primarily treat HCV patients. Here is what you need to be approved for Harvoni through BC:
You must include the following labs and they must have been completed in the last 6 weeks prior to sending:
CBC w/ platelets
AST/ALT
Total bilirubin
Serum albumin
PT/INR
Serum creatinine
GFR
Your baseline HCV RNA must have been done in the last 6 months.
Your physician must include a statement that you either 1) have been screened & tested for alcohol and illicit drug use OR 2) state that you are currently in treatment.
as well as a statement that you do not/ will not take St. John's Wort.
A fibroscan or biopsy staging score of F3 or F4 UNLESS you are coinfected with HIV and then you may be approved at lower scoring (7.0 on a fibroscan).
If possible, a Child Pugh score is helpful.
You do not have to be Genotype 1 but there are different criteria for other genotypes that I can send to you if you like. The criteria for any Anthem Blue Cross medication can be found here: https://www.anthem.com/pharmacyinformation/priorauth.html
Best of luck!
Grisel suarez
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Kandice
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Debbie Lee
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Jamie Fox
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Brent Johnson
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Marie Bingham
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Diana Colombo
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Sandra
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joseph lutch
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Cheryl Crain Gentry
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wanda hernandez
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