The controversy over the new crop of hepatitis C treatments has taken
yet another turn as consumers are starting to file lawsuits against
insurers that deny them access to the medicines. Over the past two
weeks, two different women alleged that Anthem Blue Cross refused to pay
for the Harvoni treatment sold by Gilead Sciences GILD -1.74% because it was not deemed “medically necessary.”
The issue emerges after more than a year of debate over the cost of
the medicines and complaints by public and private payers that the
treatments have become budget busters. The new hepatitis C treatments,
which are sold by Gilead Science and AbbVie, cure more than 90% of those
infected and, in the U.S., cost from $63,000 to $94,500, depending upon
the drug and regimen, before any discounts.
In response, drug makers have been pressured to offer discounts and
some state Medicaid programs, for instance, set restrictions before
providing coverage to some hepatitis C patients. By setting
restrictions, payers hope to limit the number of patients for whom
coverage is provided. And this is the tack that Anthem Blue Cross has
pursued, according to court documents.
Read more... Labels: access to drugs, Anthem, coverage, Gilead, lawsuits