Harvoni - Consumers Sue Anthem for Denying Coverage for a Gilead Hepatitis C Drug

Consumers Sue Anthem for Denying Coverage for a Gilead Hepatitis C Drug 

By Ed Silverman
Max Whittaker/Prime for The Wall Street Journal

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 -1.77% because it was not deemed “medically necessary.”

Both lawsuits claim the insurer denied coverage for Harvoni, one of two hepatitis C treatments sold by Gilead, because the amount of liver damage sustained by the women was insufficient to warrant payment for the drug. In both cases, the insurer decided that Harvoni was not medically necessary, according to the lawsuits.

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Anthem has not publicly commented on the lawsuits, but told the Wall Street Journal that limited clinical data is an issue when it comes to approving hepatitis C treatments. A spokesman noted that the newest Hepatitis C drugs have been approved through the FDA breakthrough therapy process, and have therefore been tested among fewer people than in typical clinical trials, leaving knowledge more limited for these new drugs.

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