Lawsuit Investigation for Patients Denied Coverage for Hepatitis C Drug Harvoni
Last Updated on October 13, 2022
Attorneys working with ClassAction.org are no longer investigating this matter. The information here is for reference only. A list of open investigations and lawsuits can be viewed here.
At A Glance
- This Alert Affects:
- People who weren’t covered by their health insurance for the cost of Harvoni, the first known drug to cure hepatitis C.
- What’s Going On?
- Attorneys working with ClassAction.org are investigating whether some health insurance companies are wrongfully denying coverage for Harvoni for early-stage hepatitis C in an attempt to save money at the expense of patients’ health. It's possible that class action lawsuits could be filed to help patients get the coverage they deserve.
- How Could a Class Action Help?
- A successful case could order insurance companies to change the way they handle coverage for hepatitis treatment and help recover money for patients whose insurers didn’t cover their prescriptions.
Attorneys working with ClassAction.org would like to speak to patients who weren’t covered by their health insurance for the cost of Harvoni, the first known drug to cure hepatitis C.
They are investigating whether some health insurance companies are purposely delaying coverage of this breakthrough medication until the patient has reached later stages of the disease in the hopes he or she will die or switch insurers before the company has to pay for the drug. It's possible that class action lawsuits could be filed against these health insurers, but first, the attorneys need to speak with patients who had this happen to them.
How Is Harvoni Coverage Being Denied, Exactly?
Hepatitis C has five diagnosable stages. When a patient is in the early stages of the disease – that is, stage one through three – some insurance companies will deny coverage for Harvoni by claiming that the patient isn’t “sick enough” yet and that the drug, therefore, isn’t medically necessary. Yet, it’s only a matter of time until the patient progresses to the later stages.
It is suspected that the companies’ real motive for delaying coverage of the drug – which can cost $1,000 per pill and may need to be taken daily for up to 24 weeks – is to avoid paying for it entirely.
These insurance companies are said to be resting on the hope that the patient will either die or switch insurers before they ever have to pay for the drug.
Oftentimes, patients who are denied coverage for Harvoni are given little to no explanation as to why.
United Healthcare Sued, Settled Lawsuit Over Harvoni Denials
Several big health insurance companies have already been sued over claims that they were denying coverage for Harvoni. For instance, in 2015, United Healthcare was hit with a class action lawsuit over this very issue and resolved the case with a settlement that provided up to $2,400 per claimant.
This practice may not be limited to larger insurance companies like United Healthcare and may be a common practice throughout the health insurance industry.
How Can a Class Action Lawsuit Help?
A class action could help patients recover money for being denied treatment and could also force insurance companies to change the way they handle coverage for hepatitis C treatments.
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