Anthem Hit With Class Action Over Lack of Hep C Treatment Coverage

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A class action lawsuit was filed against Anthem Blue Cross alleging that the health insurance company refuses to provide coverage to policyholders for a new treatment for hepatitis C developed by Gilead Science Inc.

Lead plaintiff, and policyholder, Marina Sheynberg filed the class action in a California federal court. In it, the plaintiff alleged that Anthem refused to cover the cost of the Gilead treatment, Harvoni, for her hepatitis C diagnosis. Sheynberg alleged that Anthem told her that her liver was not deteriorated enough to justify the $99,000, 12-week treatment.

According to the class action, Anthem is in violation of the Employee Retirement Income Security Act (ERISA).

“In violation of ERISA statutes and regulations, Anthem has systematically ignored the treatment recommendations of insureds’ providers and used internal clinical guidelines which are inconsistent with the plain language of insureds’ plans,” Sheynberg explains in her Anthem class action lawsuit.

Hepatitis C is a contagious disease that leads to liver damage, cirrhosis, and infections and can cause cancer, heart attacks and death.

The Anthem treatment denial class action lawsuit alleges that the treatment consists of a daily pill that cures 95 percent to 99 percent of hepatitis C cases. The drug was approved by the Food and Drug Administration (FDA) in October 2014, according to the complaint, which also points out that prior to Harvoni’s release, hepatits C treatments only worked 70 percent of the time and had significant side effects.

“Hepatitis C is only the second disease or condition for which a cure has been discovered in a single life-span from the discovery of the disease or condition,” Sheynberg explains in the class action lawsuit. “Hepatitis C was discovered in 1990 and the cure arrived in 2014. Hepatitis C could become completely eradicated in the coming few years as a result of Harvoni, assuming patients, such as Ms. Sheynberg, have access to this incredible cure.”

Class actions have also been filed against units of Anthem, including Blue Cross and Blue Shield, in California and Florida courts.

In response to the pending litigation, Anthem made the following statement; “Given the concerns and relative benefits and harms, our benefits support coverage for members with more advanced stages of liver disease and those at highest risk for liver complications. Broader use of these drugs and knowledge about the long term effects and potential harms and outcome of various alternative therapies are needed on those with limited effects of infection. We are continuously evaluating new information regarding drugs to treat hepatitis C including clinical responses and potential complications of therapy.”

Harvoni, the new hepatitis C drug, is also the subject of litigation alleging price gouging. States have also attempted to restrict coverage through Medicaid because of cost concerns.

Lead plaintiff, Marina Sheynberg, is represented by Glenn R. Kantor and Timothy J. Rozelle of Kantor & Kantor LLP.

The Anthem Hep C Class Action Lawsuit is Sheynberg v. Anthem Blue Cross Life and Health Insurance Co., Case No. 3:15-cv-03417, in the U.S. District Court for the Northern District of California.