A woman sued Anthem Blue Cross Friday, alleging the insurer is wrongfully refusing to pay for a new drug regimen that could help her in her battle against Hepatitis C.
Shima Andre is seeking unspecified damages on allegations of breach of contract and intentional and negligent infliction of emotional distress.
An Anthem representative could not be immediately reached.
Hepatitis C is a liver disease that can lead to potentially fatal complications, including severe liver damage, infections, cirrhosis and liver cancer. A new drug approved by the FDA in 2014 was designated as a breakthrough therapy for its ability to treat and cure the disease, Andre’s lawyers say.
In clinical trials, Harvoni cured Hepatitis C in up to 99 percent of patients within 12 weeks, according to Andre’s lawyers.
But according to the Los Angeles Superior Court lawsuit, Anthem provides the costly drug regimen only to those patients suffering from the worst stages of liver damage.
“I want to have a child, I want to enjoy motherhood, but I can’t until Blue Cross approves my treatment so that I can be cured of Hep C,” Andre said. “Blue Cross isn’t just interfering with my health; their decision is preventing me from having a child.”
Harvoni costs about $99,000 for a 12-week course of treatment, according to Andre’s lawyers. The lawsuit alleges Blue Cross would only consider approving Harvoni for Andre when a liver biopsy shows a specified amount of scarring.
“Medicine has now developed a cure for Hepatitis C, but Blue Cross has made a financial decision not to pay for it,” plaintiff’s attorney Michael J. Bidart said. “This practice needs to stop.”
— City News Service