United HealthCare HCV Settlement Upheld / Dropping Restrictions
"United only changed its guidelines because Rivero Mestre sued....Whorton said that since Rivero Mestre filed the litigation, major health insurance companies across the country have changed their guidelines to lift fibrosis restrictions.....health insurance giant United agreed to provide more than $200 million in coverage for the hepatitis C cure Harvoni.....It locked in the change to the fibrosis guidelines, ensuring United could never impose the same restrictions again.It removed the abstinence restrictions, which affected about 10 percent of the class memberssettlement created a $500,000 fund to allow former policyholders who could not afford insurance to make a claim.....state attorneys general of the proposed settlement as required by the Class Action Fairness Act, several of them stepped in to challenge it [ including ] Pennsyvania.....United HealthCare Services Inc. has agreed to expand its coverage of hepatitis C drugs as part of a nationwide class action settlement valued at more than $300 million.
The agreement, filed in Miami federal court Friday, resolves claims that theinsurance giant was unlawfully denying some policyholders coverage of a breakthrough hepatitis C cure called Harvoni.....United removed the fibrosis restrictions about seven months after the suit was filed....The agreement comes three months after a similar settlement in a case Rivero Mestre filed against Blue Cross and Blue Shield of Florida Inc. In that case, the insurer agreed to extend coverage of Harvoni to about 2,000 policyholders with early stages of hepatitis C."......this is what Medicaid lawsuits should get
Under the terms of the proposed hepatitis C drug class action settlement, United has agreed to eliminate Fibrosis Restrictions from its Clinical Pharmacy Programs for its hepatitis C drugs.
It has also agreed to begin the process of eliminating the Abstinence Restriction from any Clinical Pharmacy Programs for hepatitis C drugs and replace it with a treatment-readiness assessment.
Further, Class Members who were formerly covered by a United health plan with a medical and/or prescription drug benefit will be given the opportunity to enroll in any individual plan offered in their state by United in 2017.
United will also make payments to certain Class Members in states in which United will not offer individual plans in 2017. See "Potential Award" section below for details.
To receive a Claim Form, call1-844-607-1697 or write to the United Hepatitis C Drug Settlement Administrator at P.O. Box 3240, Portland, OR 97208-3240 for more information
WHO's Eligible -You are a Class Member of the hepatitis C drug settlement if: "(1) you are or were covered under any type of commercial health benefits plan, health insurance policy, or health maintenance organization contract, with a medical benefit or prescription drug benefit (or both) insured or administered by United; (2) while your coverage was in effect, your request for prior authorization for a Hepatitis C Drug was denied on or before August 4, 2016 based in whole or in part on a Fibrosis or Abstinence Restriction under United's Clinical Pharmacy Program for the Hepatitis C Drug; and (3) you have not subsequently received a Hepatitis C Drug."
Under the terms of the United HealthCare class action settlement, a "Hepatitis C Drug" refers to any Harvoni, Sovaldi, Olysio, Viekira Pak, or any other prescription medication that is currently approved by the FDA to treat hepatitis C.
"Fibrosis Restriction" is a requirement that a patient with hepatitis C demonstrate a certain level of hepatic fibrosis in order to obtain a prior authorization for a hepatitis C medication.
"Abstinence Restriction" is a requirement that an individual has no known history of illicit drug or alcohol abuse, or has abstained from using illicit drugs or alcohol for a certain amount of time, or who has submitted a negative urine drug test within a specific period of time to obtain prior authorization for hepatitis C.
Settlement Over Hepatitis Cure OK'd Despite Challenge From Attorneys General
Celia Ampel, Daily Business Review
February 13, 2017
A West Palm Beach federal judge gave final approval to a nationwide class action settlement of claims against United HealthCare Services Inc., rejecting a challenge from 14 state attorneys general.
Under the terms of the settlement, health insurance giant United agreed to provide more than $200 million in coverage for the hepatitis C cure Harvoni. After the Coral Gables firm Rivero Mestre sued United for providing coverage of the drug only to policyholders with severe liver fibrosis, the company removed those restrictions.
United also agreed to remove a requirement that policyholders demonstrate abstinence from drug or alcohol use for at least six months prior to treatment. In addition, the settlement created a $500,000 fund to allow former policyholders who could not afford insurance to make a claim.
When class counsel notified state attorneys general of the proposed settlement as required by the Class Action Fairness Act, several of them stepped in to challenge it. Arizona Attorney General Mark Brnovich led the effort, with the support of the attorneys general of Alabama, Arkansas, Idaho, Kansas, Louisiana, Mississippi, Nevada, North Dakota, Oklahoma, Pennsylvania, South Carolina, Texas and Wyoming.
"The settlement is imbalanced, unfair and bargains away the claims of the class members," a spokesperson for Brnovich's office said Monday in an email. "As attorneys general, we need to ensure the financial interests of others are never placed ahead of consumers."
But lawyers for both United and the policyholders argued the attorneys general were off-base.
"We had a number of conversations with them up until the final approval date," said Charlie Whorton, a Rivero Mestre attorney who worked on the case with his colleagues Andres Rivero, Alan Rolnick and Jorge Mestre. "Their main argument, which we totally disagreed with, was that the absent class members were not getting any benefit from the settlement because United had already changed its guidelines prior to the settlement with regard to the fibrosis restrictions."
The attorneys general argued in an amici curiae brief that "only the Defendant, class counsel and the named plaintiffs receive particularized value from the deal," adding that the attorney fees should only amount to $125,000.
Whorton argued the settlement did benefit the approximately 4,410 class members in many ways. It locked in the change to the fibrosis guidelines, ensuring United could never impose the same restrictions again. It removed the abstinence restrictions, which affected about 10 percent of the class members, Whorton said. And the settlement gave notice to hepatitis C patients who had no idea Harvoni was now covered by their insurance.
Any class member could opt out of the settlement and pursue any claims for monetary damages without sacrificing any of the settlement's benefits, he said.
Furthermore, Whorton said, United only changed its guidelines because Rivero Mestre sued.
"It's not like they did it out of the goodness of their heart," he said.
The plaintiffs attorneys were also unsure why the attorneys general challenged the settlement after failing to pursue claims against United in their own states.
"They never lifted a finger to try to help the sufferers who weren't getting a cure," Rivero said.
The attorneys general rejected the idea that the challenge was politically motivated and characterized the coalition as "bipartisan." All but two of the 14 attorneys general come from states with Republican governors.
Defense attorneys also felt the opposition of the attorneys general was unfounded.
"The state attorneys general lack standing to challenge the settlement, and their opposition to the settlement is not grounded in a realistic understanding of the weaknesses in the class members' claims," attorneys for United wrote in a court filing. "Viewed against those weaknesses, the settlement is fair by any standard."
The Alston & Bird lawyers who represented United did not respond to a request for comment by deadline.
U.S. District Judge Robin Rosenberg rejected the challenge, approving the settlement without any changes. She also approved a $2.75 million fee for class counsel and class representatives.
Whorton said that since Rivero Mestre filed the litigation, major health insurance companies across the country have changed their guidelines to lift fibrosis restrictions.
"This is one of the most gratifying cases we've ever done, because what we actually accomplished was not just treatment for all of our clients and the absent class members, but also treatment for people that we never represented," he said.
Case: Ilissa M. Jones et al v. United Healthcare Services et al
Case no.: 15-cv-61144-RLR
Filing date: May 29, 2015
Settlement final approval date: Jan. 30, 2017
Judge: U.S. District Judge Robin Rosenberg
Plaintiffs attorneys: Andres Rivero, Jorge Mestre, Alan Rolnick and Charles Whorton,
Rivero Mestre, Coral Gables
Defense attorneys: Kristy Brown, William Jordan and Brian Stimson, Atlanta, and Brian Boone, Charlotte, North Carolina, Alston & Bird; Michael Tein, Lewis Tein, Miami
Settlement value: Approximately $200 million
United Health Expands Hepatitis C Drug Coverage to Settle National Class Action
Celia Ampel, Daily Business Review
September 12, 2016
United HealthCare Services Inc. has agreed to expand its coverage of hepatitis C drugs as part of a nationwide class action settlement valued at more than $300 million.
The agreement, filed in Miami federal court Friday, resolves claims that the insurance giant was unlawfully denying some policyholders coverage of a breakthrough hepatitis C cure called Harvoni.
Before Harvoni was approved by the Food and Drug Administration in 2014, there was no effective treatment for the disease-let alone a cure-according to court documents. The drug cures hepatitis C in 95 to 99 percent of cases.
But when Pompano Beach resident Ilissa Jones was prescribed the drug by her gastroenterologist, United declined to pay for it. The Minnesota-based company had decided to cover Harvoni only for hepatitis C patients with severe liver fibrosis.
"In other words, [United] decided that Ms. Jones hadn't suffered enough, and her liver hadn't been damaged enough, by a disease that causes irreparable harm and death, for which a cure is finally available," said Jones' lawsuit, filed in May 2015 by Coral Gables attorneys Andres Rivero, Alan Rolnick, Charlie Whorton and Daniel Sox of Rivero Mestre.
United removed the fibrosis restrictions about seven months after the suit was filed. With the settlement, the insurance company also agreed to remove a requirement that policyholders demonstrate abstinence from drug or alcohol use for at least six months prior to treatment.
"United Healthcare's policy for members covered under employer-based and individual commercial plans contains no restriction on receiving hepatitis C medications based on fibrosis score," a spokeswoman said Monday. "If the settlement is approved, United Healthcare's policy requiring a period of abstinence to be eligible for hepatitis C medications will be replaced with physicians' treatment readiness review."
United also agreed to create a fund of $500,000 to allow former policyholders to buy insurance again, whether it's from United or another insurer. That clause was included for anyone who couldn't get insurance through health insurance exchanges from United.
"We think the settlement is fair, reasonable, and adequate for the settlement class members," the plaintiffs attorneys said in a statement. "We are pleased to have resolved this litigation and reached a settlement that is in the best interests of the class and provides expanded coverage for a cure to thousands of people nationwide who suffer from a life-threatening disease."
According to the preliminary approval motion, the list price for Harvoni is $63,000 for an 8-week course of therapy and the settlement applies to approximately 5,000 people, bringing the potential value to class members to more than $300 million.
The agreement comes three months after a similar settlement in a case Rivero Mestre filed against Blue Cross and Blue Shield of Florida Inc. In that case, the insurer agreed to extend coverage of Harvoni to about 2,000 policyholders with early stages of hepatitis C.
The United settlement comes after "rigorous, arm's-length" negotiations mediated by Paul C. Huck Jr. of Jones Day in Miami, according to court documents.
The parties now await preliminary approval of the settlement from U.S. District Judge Robin L. Rosenberg.
United HealthGroup is America's largest health insurer with $157 billion in annual revenue and is the sixth-largest company in the U.S. on the Fortune 500 list.