Consumers Sue Anthem for Denying Coverage for a Gilead Hepatitis C Drug

The controversy over the new crop of hepatitis C treatments has taken yet another turn as consumers are starting to file lawsuits against insurers that deny them access to the medicines. Over the past two weeks, two different women alleged that Anthem Blue Cross refused to pay for the Harvoni treatment sold by Gilead Sciences GILD -1.74% because it was not deemed “medically necessary.”

The issue emerges after more than a year of debate over the cost of the medicines and complaints by public and private payers that the treatments have become budget busters. The new hepatitis C treatments, which are sold by Gilead Science and AbbVie, cure more than 90% of those infected and, in the U.S., cost from $63,000 to $94,500, depending upon the drug and regimen, before any discounts.

In response, drug makers have been pressured to offer discounts and some state Medicaid programs, for instance, set restrictions before providing coverage to some hepatitis C patients. By setting restrictions, payers hope to limit the number of patients for whom coverage is provided. And this is the tack that Anthem Blue Cross has pursued, according to court documents.

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Aetna CEO says no decision yet on how to cover hepatitis C drugs

Jan 13 (Reuters) - The chief executive of health insurer Aetna Inc on Tuesday said that the company had not yet decided which hepatitis C drugs to cover now that there are two breakthrough treatments on the market, but said that the company was actively working on a decision.

Investors are watching closely to see how insurers decide to cover these drugs, which cost tens of thousands of dollars per treatment, after AbbVie Inc started a competitor to Gilead Sciences' breakthrough hepatitis C treatment.

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CVS will cover Gilead hepatitis C treatment over new AbbVie drug

CVS Health Corp., one of the largest U.S. managers of drug benefits, said it would give the hepatitis C treatment from Gilead Sciences Inc. preferred status and cover a new competing treatment from AbbVie Inc. only as an exception, CNBC reported on Monday.

Shares in Gilead rose nearly 3 percent after the report that CVS would favor the treatment, which can cost about $84,000, or $1,000 per pill. Its cost has spurred a national debate about whether drug prices had soared too high.

Two weeks ago, the nation's largest drug benefits manager, north St. Louis County-based Express Scripts Holding Co., said it would cover a competing, newly approved treatment from AbbVie rather than Gilead, and Gilead shares fell sharply.

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