Harvoni is a Hepatitis C medication, sold by Gilead Sciences. It is by all accounts highly effective, with a higher than 90 percent cure rate. It also comes with few side effects. That’s good news, because Hepatitis C is deadly, with more than 15,000 Americans reportedly dying each year due to Hepatitis C complications, including liver disease.
So what’s the problem? You might wonder. If there’s a drug that can cure a life-threatening disease and it comes with few side effects, why should there be an issue? The issue, some say, is the price tag. A 12-week treatment course of Harvoni costs around $99,000. Now, $99,000 for a life-saving treatment might still sound like an okay deal, but drug companies have allegedly told some patients that the treatment isn’t medically necessary.
Even worse, they’ve allegedly told patients the treatment isn’t necessary despite letters from doctors explaining the treatment is, indeed, necessary. So insurance companies are reportedly overruling doctors on the medical necessity of a drug with high effectiveness that treats a life-threatening disease.
No wonder the relationship between healthcare providers and insurance companies is tense.
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For now, lawsuits have been filed against some insurers, alleging they are in breach of contract for failing to provide coverage for medically necessary treatment. The lawsuits also allege that insurers have put profits before patients.
For their part, insurers argue that Harvoni was approved through a process that allowed for approval with less rigorous testing, meaning the drug’s effectiveness and safety have not been adequately studied.
Who the courts agree with remains to be seen.