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Harvoni Investigation Focuses on Problematic Insurance Industry Practices

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Washington, DCPatients who have a life-threatening illness typically pray for a cure to be found. They don’t tend to expect that if a cure is found and approved by the FDA, that they would then have to fight with insurance companies to have their treatment covered. Unfortunately for many patients with hepatitis C, insurance companies are allegedly denying them access to curative treatments like Harvoni, arguing that patients aren’t sick enough. But some question whether the denials are motivated by profit, instead of patient well-being or medical necessity. “There are patients with hepatitis C whose doctors are prescribing Harvoni as a curative treatment, but they are being denied the treatment by insurance companies,” Anna Haac, attorney at Tycko & Zavareei LLP, says.

Harvoni is a recently approved cure for hepatitis C, a contagious, potentially fatal liver disease. Patients with hepatitis C can develop complications such as liver damage, cirrhosis of the liver and liver cancer.

There wasn’t a widely effective and well-tolerated cure for hepatitis C until October 2014, when the FDA approved Harvoni, designating it a breakthrough therapy. Studies show Harvoni can cure 94 to 99 percent of hepatitis C cases, but it’s an expensive drug.

Treatment with Harvoni can cost up to $99,000 for a 12-week treatment program. But studies have shown it to not only be effective but also have few side effects. As soon as it was approved, doctors began prescribing Harvoni to their hepatitis C patients.

According to reports, 15,000 people die in the US annually from complications linked to hepatitis C. More than three million people in the US have chronic hepatitis C. Once hepatitis C has developed, approximately 70 percent of patients will develop chronic liver disease, which puts them at increased risk of cirrhosis and liver cancer. Even without the disease advancing to life-threatening stages, patients can suffer fatigue, pain, severe headaches and nausea, affecting their daily living and ability to work. Insurance companies have allegedly denied Harvoni treatment arguing that the patient’s liver was too healthy and therefore did not require treatment.

Physicians find these insurance company practices problematic. The American Association for the Study of Liver Disease has condemned the denial of curative hepatitis C treatment by insurance companies, stating in a press release that patients who receive advice from their doctor to take the newest hepatitis C medications should not be denied.
“It is doctors, not insurance companies, who should be determining how best to treat their patients,” Haac says.


Policyholders may have a legal claim against their insurance companies if denied these curative treatments, but they often face legal hurdles in pursuing them. “Patients who have had their insurance claim for curative hepatitis C treatment denied should contact us,” Haac says.

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READER COMMENTS

Posted by

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I have hep c for 26 years I have been on interferon and pegatron treated with ribivarin and denied treatment cause viral load did not drop according to insurance companies. Now harvoni and insurance denies cause I am only stage f 1 but I do not drink or take drugs and am a grandmother and suffering symptoms but I am no sick enough accoding to UPMC insurance and I work as a nurse everyday but I am not sick enough Help how can I help be an advocate myself and for others.

Posted by

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I HAVE HAD HEP-C FOR ABOUT 30 YEARS, I AM63 YEARS OLD, I NEED THE MEDICINE NOW ,NOT IN 10 MORE YEARS ,I WANT TO LIVE TO SEE MY GRANDKIDS AND GREATGRANDKIDS GROW UP,WHY CAN I NOT GET IT NOT RICH ENOUGH ? THEY SAY I AM NOT SICK ENOUGH HOW SICK DO YOU HAVE TO BE,ON YOUR DEATH BED

Posted by

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I have had Hepatitis C since 1981. I was treated with interferon in 1998 unsuccessfully. I began having multiple medical problems as a direct result of my long term hepatitis C infection in early 2013. These incluse leukocytoclastic vasculitis (an autoimmune disease in which the immune system attacks the blood vessels), peripheral neuropathy and mesenteric artery blockages leading to abdominal bypass surgery in 2014. I have to take prednisone daily for the vasculitis. The prednisone has caused cataracts in both eyes (I have had cataract surgery in both eyes), worsening of my osteoporosis and thinning skin which leads to bruising and skin sores. I have been turned down three times by Blue Cross Blue Shield of TN for the new hepatitis C medicines.

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