Customers of Anthem Blue Cross in California have dropped their class-action lawsuit against the insurer after the company reversed its policy of refusing to cover hepatitis C virus (HCV) treatment to all but the sickest patients enrolled on its plans. Moving forward, almost all HCV-positive beneficiaries of the health care giant will be able to access a cure within six months of diagnosis, and anyone previously denied coverage will be retroactively approved for treatment, Courthouse News reports.
The lawsuit, originally filed in July 2015, claimed that Anthem Blue Cross was in direct violation of the Employer Retirement Income Security Act when it told thousands of HCV-positive customers that they lacked sufficient scarring and liver damage to qualify for the latest hepatitis C treatments—which can cure up to 99 percent of people diagnosed with the illness. At the time, the insurer’s treatment policy applied only to members at the most advanced stages of liver disease.
Shortly after its customers sued, Anthem reversed this policy and agreed to expand hepatitis C treatment coverage starting January 1, 2016. Then, in August, the insurer revised its coverage criteria once again, saying it would cover Harvoni (ledipasvir, sofosbuvir) treatment for all its patients after six months of diagnosis.
Anthem also said it would send notices about the change to all its members in the state of California who had been denied coverage and would retroactively approve their claims for treatment. In light of these changes, plaintiffs agreed to drop the case without the need for a formal class settlement or approval. On October 31, U.S. District Judge Vince Chhabria approved the voluntary dismissal of the case.
Moving forward, Anthem will cover six of the newest hepatitis C virus treatments—Sovaldi (sofosbuvir), Harvoni (ledipasvir, sofosbuvir), Olysio (simeprevir), Daklinza (daclatasvir), Viekira Pak (dasabuvir, ombitasvir, paritaprevir, ritonavir) and Technivie (ombitasvir, paritaprevir, ritonavir)—to those at all stages of liver fibrosis, with a few clinical conditions.