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United Health Expands Hepatitis C Drug Coverage to Settle National Class Action
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http://www.dailybusinessreview.com/id=1202767146286/Insurer-Expands-Hepatitis-Cure-Coverage-to-Settle-Nationwide-Class-Action?slreturn=20160813171113
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.
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