Blue Cross Sued Over Denying Patients Hepatitis C Treatment

November 30, 2015

In California, a class action lawsuit has been filed on behalf of thousands of Blue Cross beneficiaries living with hepatitis C who were denied treatment.

New hepatitis C drugs may have high cure rates, but they come at a high price—one that insurers might not be willing to pay. A recent study found that in 4 states, approximately 16% of patients submitting a prescription for Harvoni or Sovaldi were denied the new drug. Another study from Yale University found that one-fourth of patients are initially denied these lifesaving drugs.

For patients denied these drugs, they can go through several steps of appeal, but ultimately if they are still denied they simply have to wait until they get sicker.

In California, a class action lawsuit has been filed on behalf of Signe K. Johnson and thousands of Blue Cross beneficiaries who are living with hepatitis C. According to the lawsuit, Blue Cross is limiting authorization to only its sickest patients.

“Blue Cross selfishly decided to protect their profits over the lives of their insured members who have contracted this progressive and deadly disease,” lead attorney Robert Gianelli with Gianelli & Morris, who represents the plaintiff, said in a statement.

The law firm alleges that after Johnson made repeated attempts to get authorized for Harvoni, she was denied because the treatment was “not medically necessary.”

In May, a class action lawsuit was filed in Florida against Blue Cross and Blue Shield of Florida, alleging that it had wrongly denied beneficiaries Harvoni. In the case Kondell v Blue Cross and Blue Shield of Florida Inc, the plaintiff Janie Kondell was denied treatment because her “liver had not sufficiently deteriorated,” according to the suit.

In California, after being denied treatment, Johnson paid for the 8-week course of medication and after treatment had no detectable trace of the virus, according to Gianelli & Morris.

“Rather than embrace this breakthrough, Blue Cross developed a phony ‘not medically necessary’ policy that denied this medical miracle to those who would most benefit from the treatment, such as Ms Johnson,” said Gianelli.