Two Washington state health insurers are being targeted in class-action lawsuits that claim the carriers are unfairly rationing expensive new drugs treating Hepatitis C.
Filed in King County Superior Court, the suits allege that Group Health Cooperative and BridgeSpan Insurance, a subsidiary of Regence BlueShield, are unfairly limiting the use of drugs like Harvoni and Sovaldi – which costs about $95,000 for a 12-week course – based on their hefty price tag rather than medical necessity.
According to the complaint against Group Health, the insurer “has put in place internal coverage restrictions that impermissibly deny all its insureds access to curative treatment for HCV solely because it is perceived to be expensive by GHC.
“Specifically, GHC rations treatment, excluding all coverage except to the most severely ill insureds.”
The complainants are those who have had their claims for Hep C drugs denied by their insurers with denial letters explaining that the treatments are limited to people with more severe infection.
While Medicaid programs have long denied consumers without the most severe fibrosis access to the more than $1,000-a-pill drugs, the move by private insurers to restrict access is new.
Given the American Association for the Study of Liver Diseases’ endorsement of these drugs as the standard for medical care for Hep C, the insurers’ practice is illegal, attorneys for complainants argue.
The outcome of the lawsuits will have significant bearing on future insurance practices. Washington state Insurance Commissioner Mike Kreidler has already omitted himself from the discussion, saying he has encouraged insurance companies to follow the medical standard of care but without real authority.
“They really need to, from my perspective, follow the medical guidelines, and if they don’t, we have a process to challenge them on that,” Kreidler told the Seattle Times, referring to the courts.
Neither insurance company has commented on the lawsuits.
