Improper Insurance Coverage Denial for Gilead’s Sovaldi and Harvoni Drugs
Chimicles & Tikellis is investigating a potential class action lawsuit on behalf of people who are insured by an employee-sponsored health plan and were denied insurance coverage for the Hepatitis-C drugs Sovaldi or Harvoni. These drugs can reportedly cure nearly 100% of patients with the most common form of Hepatitis-C in three to six months, and can do so with relatively minor side effects compared to earlier available treatments.
C&T is investigating whether certain employee-sponsored health plans have been improperly denying or limiting coverage for these life-saving drugs due to pricing considerations unrelated to whether they are medically necessary. C&T is investigating whether this conduct may have violated the Racketeering Influenced and Corrupt Organizations Act (RICO) and/or the Employee Retirement Income Security Act (ERISA). Blue Cross and Blue Shield of Florida recently agreed to settle a class action lawsuit involving similar allegations on terms which made Harvoni available to all of its members who needed the drug. Specifically, Blue Cross changed its prior policy of denying coverage for Harvoni for people whose livers were not yet sufficiently scarred (a condition called fibrosis).
If you are insured by an employee-sponsored health plan through a Blue Cross affiliate in another area (or by a plan issued through another insurance company) and have been denied coverage for Sovaldi or Harvoni, please contact us to discuss this investigation.