United HealthCare Hepatitis C Drug Class Action Settlement

A settlement has been reached in a class action lawsuit alleging United HealthCare Services denied prior authorization for prescription Hepatitis C drugs for certain individuals with a medical and/or prescription drug benefit.

The defendants named in the hepatitis C drug class action settlement include United HealthCare Services Inc., United HealthCare Inc., Neighborhood Health Partnership Inc. and United HealthCare Life Insurance Co. (“United defendants”).

The hepatitis C drug class action lawsuit was filed by plaintiffs Ilissa Jones and Wendy Shanker, who allege the United defendants improperly limited coverage of hepatitis C drugs for individuals with advanced liver fibrosis. They assert that this limitation of coverage violated federal law and Florida contract law.

The hepatitis C drugs covered by this class action settlement include Harvoni, Sovaldi, Olysio, Viekira Pak or any other prescription drug that has been approved by the U.S. Food and Drug Administration to treat hepatitis C.

The defendants deny that they did anything wrong. However, they have agreed to settle the hepatitis C drug class action lawsuit to avoid the cost and uncertainty of trial.

Under the terms of the proposed hepatitis C drug class action settlement, United has agreed to eliminate Fibrosis Restrictions from its Clinical Pharmacy Programs for its hepatitis C drugs.

It has also agreed to begin the process of eliminating the Abstinence Restriction from any Clinical Pharmacy Programs for hepatitis C drugs and replace it with a treatment-readiness assessment.

Further, Class Members who were formerly covered by a United health plan with a medical and/or prescription drug benefit will be given the opportunity to enroll in any individual plan offered in their state by United in 2017.

United will also make payments to certain Class Members in states in which United will not offer individual plans in 2017. See “Potential Award” section below for details.

Who’s Eligible

You are a Class Member of the hepatitis C drug settlement if: “(1) you are or were covered under any type of commercial health benefits plan, health insurance policy, or health maintenance organization contract, with a medical benefit or prescription drug benefit (or both) insured or administered by United; (2) while your coverage was in effect, your request for prior authorization for a Hepatitis C Drug was denied on or before August 4, 2016 based in whole or in part on a Fibrosis or Abstinence Restriction under United’s Clinical Pharmacy Program for the Hepatitis C Drug; and (3) you have not subsequently received a Hepatitis C Drug.”

Under the terms of the United HealthCare class action settlement, a “Hepatitis C Drug” refers to any Harvoni, Sovaldi, Olysio, Viekira Pak, or any other prescription medication that is currently approved by the FDA to treat hepatitis C.

“Fibrosis Restriction” is a requirement that a patient with hepatitis C demonstrate a certain level of hepatic fibrosis in order to obtain a prior authorization for a hepatitis C medication.

“Abstinence Restriction” is a requirement that an individual has no known history of illicit drug or alcohol abuse, or has abstained from using illicit drugs or alcohol for a certain amount of time, or who has submitted a negative urine drug test within a specific period of time to obtain prior authorization for hepatitis C.

Potential Award

Up to $2,400

United will make payments to certain Class Members in states in which United will not be offering individual plans in 2017. Class Members may submit a claim for payment of up to $2,400 if they show that they are no longer covered under a commercial health benefits plan, health insurance policy, or health maintenance organization contract with a medical and/or prescription drug benefit administered by United.

Class Members must be able to prove that they either do not have benefits through another company or through Medicare, Medicaid or any other government-funded health coverage program, or that their new health benefits provider has denied coverage for hepatitis C drugs because of a Fibrosis or Abstinence Restriction.

Proof of Purchase

Class Members who are submitting claims for payment must provide documentation to prove that they are no longer covered under a commercial health benefits plan, health insurance policy or health maintenance organization contract with a medical and/or prescription drug benefit administered by United.

Claim Form

To receive a Claim Form, call 1-844-607-1697 or write to the United Hepatitis C Drug Settlement Administrator at P.O. Box 3240, Portland, OR 97208-3240 for more information.

Claim Form Deadline

1/5/2017

Case Name

Jones, et al. v. United HealthCare Services Inc., et al., Case No. 0:15-cv-61144, in the U.S. District Court for the Southern District of Florida

Final Hearing

1/18/2017

Settlement Website

www.HepatitisCDrugSettlement.com

Claims Administrator

United Hepatitis C Drug Settlement Administrator
c/o Epiq Systems Inc.
P.O. Box 3240
Portland, OR 97208-3240
(844) 607-1697

Class Counsel

RIVERO MESTRE LLP

Defense Counsel

ALSTON & BIRD LLP