By NICHOLAS IOVINO
SAN FRANCISCO (CN) – Anthem Blue Cross refuses to cover a revolutionary new treatment that can cure most cases of hepatitis C within 12 weeks, according to a new federal class action.
Marina Sheynberg sued Anthem Blue Cross Life and Health Insurance Company on July 24, alleging the company denied her coverage of a medically necessary treatment in violation of the Employee Retirement Income Security Act.
“Hepatitis C could become completely eradicated in the coming years as a result of Harvoni, assuming patients, such as Ms. Sheynberg, have access to this incredible cure,” the lawsuit states.
Harvoni, a once-daily prescription pill that cured 94 to 99 percent of hepatitis C patients in clinical studies, was approved by the FDA last year, according an October 2014 FDA announcement.
Hepatitis C is a liver infection caused by the hepatitis C virus, a contagious virus transmitted by blood that affects about 2.7 million Americans and at least 130 million people globally, according to the U.S. Centers for Disease Control and Prevention and World Health Organization.
Before Harvoni was approved, the standard of care for hepatitis C was a three-drug treatment that cost $170,000 and came with a range of negative side effects, the plaintiff says.
“That three-drug treatment provided a 70 percent cure rate but came with tremendous adverse side effects including anemia, insomnia, anxiety, depression and memory loss,” the complaint states.
Harvoni costs $99,000 for 12 weeks of treatment with few or no harmful side effects, according to the plaintiff.
Sheynberg says Anthem denied her coverage of the treatment, telling her test results showed she lacked sufficient scarring and liver damage to quality for coverage.
“Anthem left Ms. Sheynberg to live with daily pain, depression and chronic fatigue, and to wait until her liver drastically worsened before Anthem would approve the medication,” the complaint states.
The plaintiff seeks an injunction ordering Anthem to reconsider all claims for Harvoni treatment and to pay out health benefits, and disgorgement of all profits retained from Anthem’s “wrongful denials” of the treatment.
Sheynberg’s attorney, Glenn Kantor of Kantor & Kantor in Northridge, and Anthem Blue Cross did not immediately return requests for comment.
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