Hep C patient sues Blue Cross for denying Harvoni coverage

May 19, 2015

A Hepatitis C patient is suing Blue Cross because the payer will not cover her Harvoni medication. According to the complaint, filed this week in Los Angeles Superior Court by Shernoff Bidart Echeverria Bentley LLP, Blue Cross has arbitrarily chosen to give the treatment only to those patients suffering from the worst stages of liver damage.

A hepatitis C patient is suing Blue Cross because the payer will not cover her Harvoni medication.

According to the complaint, filed this week in Los Angeles Superior Court by Shernoff Bidart Echeverria Bentley LLP, Blue Cross has arbitrarily chosen to give the treatment only to those patients suffering from the worst stages of liver damage.

The plaintiff, Shima Andre, alleges that patients like herself – who have hepatitis C but are not in the worst stages of the disease – have been told they must first suffer from serious liver damage and then they will be eligible for Harvoni. Harvoni costs an estimated $99,000 for a 12-week course of treatment.

Related:FDA warns about serious reactions to Harvoni, Sovaldi

The lawsuit alleges Blue Cross would only consider approving Harvoni when Andre's "liver has a certain amount of scarring (advanced fibrosis of stage F3 or greater) on a liver biopsy."

Related: Hep C, cancer drugs make up bigger percentage of Rx costs

"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," Andre said in a statement from Shernoff Bidart Echeverria Bentley. "Blue Cross isn't just interfering with my health; their decision is preventing me from having a child."

There were more than 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, according to a study sanctioned by the Governor of California and the California State Health and Human Services Agency. Throughout the United States, there are 3 million to 4 million Americans infected with hepatitis C.

Read more: States blame hep C cases for increased opioid abuse