Plaintiffs allege Blue Cross withholds Harvoni treatment for financial reasons
Blue Cross Withholds Cure from Hepatitis C Patients, Lawsuit Claims
LOS ANGELES, May 15, 2015 /PRNewswire/ -- Shernoff Bidart Echeverria Bentley LLP filed a lawsuit in Los Angeles Superior Court today accusing Blue Cross of withholding a cure for Hepatitis C based only upon profits, in violation of California law.
The plaintiff, Shima Andre, suffers from Hepatitis C, a contagious liver disease that can lead to complications including severe liver damage, infections, cirrhosis, liver cancer, and even death. But a new treatment is radically changing the lives of those living with Hepatitis C. The treatment—Harvoni— was just approved by the FDA in 2014 and was even designated as a "breakthrough therapy" for its revolutionary ability to treat and cure Hepatitis C. In clinical trials, Harvoni cured Hepatitis C in 95-99% of patients within only twelve weeks.
But according to the lawsuit, Blue Cross has arbitrarily chosen to give the treatment only to those patients suffering from the worst stages of liver damage. Despite the opinions of other patients' treating doctors, they are told by Blue Cross that they must wait for the cure, suffer serious liver damage, and only then will they be eligible for Harvoni. No known medical study supports this decision—and no part of Shima's insurance policy grants Blue Cross this arbitrary authority.
"I want to have a child, I want to enjoy motherhood, but I can't until Blue Cross approves my treatment so that I can be cured of Hep C," said plaintiff Shima Andre. "Blue Cross isn't just interfering with my health; their decision is preventing me from having a child."
Harvoni is an expensive drug, costing an estimated $99,000 for a 12-week course of treatment. The lawsuit alleges Blue Cross would only consider approving Harvoni when Mrs. Andre's "liver has a certain amount of scarring (advanced fibrosis of stage F3 or greater) on a liver biopsy."
"Medicine has now developed a cure for Hepatitis C, but Blue Cross has made a financial decision not to pay for it," said attorney Michael J. Bidart. "This practice needs to stop."
According to a study sanctioned by the Governor of California and the California State Health and Human Services Agency, there were over 500,000 chronic hepatitis C cases in California as of 2011, and almost 50,000 new cases in Los Angeles County alone between 2007 and 2011. Throughout the United States there are three million to four million Americans infected with hepatitis C.
"Imagine a healthcare company telling their patients with Hepatitis C that they're not sick enough yet to get a known cure," said attorney Ricardo Echeverria. "Blue Cross is simply putting profits over patients."
The lawsuit is Shima Andre v. Blue Cross. The case was filed in the Los Angeles Superior Court, Case No. BC582063.
About Shernoff Bidart Echeverria Bentley LLP
At Shernoff Bidart Echeverria Bentley we lead the nation in protecting policyholders from insurance company abuse. The firm has been protecting the rights of insurance consumers, both individuals and businesses, for 40 years after having set the legal precedent requiring insurance companies to act in good faith.