Blue Cross and Blue Shield of Florida Inc. agreed to expand coverage
of a breakthrough cure for Hepatitis C to about 2,000 policyholders as
part of a settlement negotiated by Miami lawyers.
The first public details of the settlement were filed late Thursday with U.S. District Judge Robin L. Rosenberg in West Palm Beach.
The settlement arose from claims filed by Rivero Mestre attorneys alleging the insurer, known as Florida Blue, was unlawfully withholding coverage from policyholders with early stages of Hepatitis C.
Only those with severe liver fibrosis were covered for prescriptions of Harvoni, a 95 to 99 percent effective cure for Hepatitis C that was approved by the Food and Drug Administration in October 2014, Rivero Mestre partner Andres Rivero said.
"If you take this pill, you're—in most circumstances—done with what was a previously incurable disease," he said.
The plaintiffs claimed the insurer was motivated by sticker shock, as Harvoni costs $63,000 for an 8-week course of therapy and $94,500 for 12 weeks.
Before Harvoni, treatments for Hepatitis C had low cure rates and side effects, Rivero said.
As a result, the American Association for the Study of Liver Diseases recommended those treatments only be given to people with severe fibrosis, while patients with less advanced hepatitis should hold out for the next pipeline of more effective and less harmful drugs.
Within a month of Harvoni's FDA approval, the association changed its standard of care from "watchful waiting" for the earlier-stage patients to "treatment for all," Rivero said.
Insurers such as Florida Blue knew Harvoni was on the horizon and that the medical society's recommendations would change as soon as it was released, but they still did not change their guidelines, he said.
"They stuck in, as the basis for their covering or not covering, the society's statements from the timeline before Harvoni was approved, which was the watchful waiting standard," Rivero said.
Rivero Mestre filed two cases against Florida Blue, one on behalf of people with employer-sponsored plans and the other on behalf of people with plans they purchased themselves.
The motion for preliminary approval of the settlement was filed in the case related to employer-sponsored plans, captioned Oakes v. Blue Cross and Blue Shield of Florida, but covers both groups of plaintiffs. Rosenberg dismissed the other case, Kondell v. Blue Cross and Blue Shield of Florida, with prejudice May 9.
Rivero Mestre planned to appeal the Kondell order and had moved for class certification in the Oakes case, with the defendant's opposition brief due May 17. Before that deadline, the parties agreed to sit for a third mediation led by Paul Huck Jr., who is also a litigator with Jones Day in Miami.
That mediation led to the settlement, with Florida Blue agreeing to add about $126 million to $189 million of coverage for Harvoni and remove restrictions based on the liver deterioration of policyholders with Hepatitis C. Rivero Mestre requested $2.24 million in attorney fees.
Negotiations were "rigorous," according to Thursday's filing, and the parties needed a four-day deadline extension and extra mediation from Huck to finalize the agreement.
Florida Blue and its lawyers declined to comment Tuesday about why the company agreed to extend its coverage. The insurer is represented by McDermott Will & Emery attorneys Marcos Jimenez, Justin Uhlemann and Robert Kline in Miami and Christopher Murphy in Chicago.
Rivero Mestre also sued United Healthcare in 2015 for a similar lack of coverage. United changed its guidelines Jan. 1 of this year, offering to cover Harvoni for all policyholders with Hepatitis C.
But the case is still pending, and two law firms in California and Minnesota brought copycat lawsuits and are trying to consolidate the cases as multidistrict litigation, Rivero said.
While the Florida Blue settlement only deals with policyholders in one state, it will still make a significant impact, said Rivero Mestre partner Charlie Whorton, who first brought the insurance gaps to Rivero's attention. He worked on the cases with Rivero, Alan Rolnick and Daniel Sox.
"It's a substantial victory, especially given the risks that protracted litigation presented to the class," Whorton said.
The first public details of the settlement were filed late Thursday with U.S. District Judge Robin L. Rosenberg in West Palm Beach.
The settlement arose from claims filed by Rivero Mestre attorneys alleging the insurer, known as Florida Blue, was unlawfully withholding coverage from policyholders with early stages of Hepatitis C.
Only those with severe liver fibrosis were covered for prescriptions of Harvoni, a 95 to 99 percent effective cure for Hepatitis C that was approved by the Food and Drug Administration in October 2014, Rivero Mestre partner Andres Rivero said.
"If you take this pill, you're—in most circumstances—done with what was a previously incurable disease," he said.
The plaintiffs claimed the insurer was motivated by sticker shock, as Harvoni costs $63,000 for an 8-week course of therapy and $94,500 for 12 weeks.
Before Harvoni, treatments for Hepatitis C had low cure rates and side effects, Rivero said.
As a result, the American Association for the Study of Liver Diseases recommended those treatments only be given to people with severe fibrosis, while patients with less advanced hepatitis should hold out for the next pipeline of more effective and less harmful drugs.
Within a month of Harvoni's FDA approval, the association changed its standard of care from "watchful waiting" for the earlier-stage patients to "treatment for all," Rivero said.
Insurers such as Florida Blue knew Harvoni was on the horizon and that the medical society's recommendations would change as soon as it was released, but they still did not change their guidelines, he said.
"They stuck in, as the basis for their covering or not covering, the society's statements from the timeline before Harvoni was approved, which was the watchful waiting standard," Rivero said.
Rivero Mestre filed two cases against Florida Blue, one on behalf of people with employer-sponsored plans and the other on behalf of people with plans they purchased themselves.
The motion for preliminary approval of the settlement was filed in the case related to employer-sponsored plans, captioned Oakes v. Blue Cross and Blue Shield of Florida, but covers both groups of plaintiffs. Rosenberg dismissed the other case, Kondell v. Blue Cross and Blue Shield of Florida, with prejudice May 9.
Rivero Mestre planned to appeal the Kondell order and had moved for class certification in the Oakes case, with the defendant's opposition brief due May 17. Before that deadline, the parties agreed to sit for a third mediation led by Paul Huck Jr., who is also a litigator with Jones Day in Miami.
That mediation led to the settlement, with Florida Blue agreeing to add about $126 million to $189 million of coverage for Harvoni and remove restrictions based on the liver deterioration of policyholders with Hepatitis C. Rivero Mestre requested $2.24 million in attorney fees.
Negotiations were "rigorous," according to Thursday's filing, and the parties needed a four-day deadline extension and extra mediation from Huck to finalize the agreement.
Florida Blue and its lawyers declined to comment Tuesday about why the company agreed to extend its coverage. The insurer is represented by McDermott Will & Emery attorneys Marcos Jimenez, Justin Uhlemann and Robert Kline in Miami and Christopher Murphy in Chicago.
Rivero Mestre also sued United Healthcare in 2015 for a similar lack of coverage. United changed its guidelines Jan. 1 of this year, offering to cover Harvoni for all policyholders with Hepatitis C.
But the case is still pending, and two law firms in California and Minnesota brought copycat lawsuits and are trying to consolidate the cases as multidistrict litigation, Rivero said.
While the Florida Blue settlement only deals with policyholders in one state, it will still make a significant impact, said Rivero Mestre partner Charlie Whorton, who first brought the insurance gaps to Rivero's attention. He worked on the cases with Rivero, Alan Rolnick and Daniel Sox.
"It's a substantial victory, especially given the risks that protracted litigation presented to the class," Whorton said.
No comments:
Post a Comment