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Class Drops Claim|for Hepatitis C Drug

SAN FRANCISCO (CN) — Anthem Blue Cross customers dropped their class action against the insurer after the company reversed its policy of refusing to cover a revolutionary treatment that cures most cases of hepatitis C.

Lead plaintiff Marina Sheynberg filed a federal class action against Anthem Blue Cross Life and Health Insurance Company in July 2015.

She claimed the insurer denied coverage of a medically necessary treatment, in violation of the Employee Retirement Income Security Act.

Harvoni, a once-daily prescription pill that cured 94 to 99 percent of hepatitis C patients in clinical studies, was approved by the FDA in 2014.

Prior to its approval, the standard hepatitis C treatment was a three-drug cocktail with a 70 percent cure rate that cost $170,000 and came with a barrage of negative side effects.

Harvoni costs $99,000 for 12 weeks of treatment, with few or no harmful side effects.

Sheynberg complained that Anthem denied her and others coverage for the revolutionary treatment, claiming her test results showed she lacked sufficient scarring and liver damage to qualify.

"Anthem left Ms. Sheynberg to live with daily pain, depression and chronic fatigue, and to wait until her liver drastically worsened before Anthem would approve the medication," the 37-page complaint states.

After Sheynberg and others sued, Anthem reversed its policy and agreed to expand coverage of the wonder drug starting Jan. 1, 2016.

In a joint statement filed with the court on Aug. 31, attorneys for Anthem and the plaintiff class said the insurer had "revised its prior authorization criteria" and would cover Harvoni for all hepatitis C patients after six months of diagnosis.

Anthem said it would send notices to all of its members in California who have been denied coverage, and will retroactively approve their claims for treatment.

"In light of this, the parties do not believe a formal class settlement or approval is required," the attorneys told the court in their Aug. 31 statement.

On Oct. 31, U.S. District Judge Vince Chhabria approved the parties' voluntary dismissal of the class action with prejudice.

Sheynberg's attorney, Glen Kantor of Kantor & Kantor in Northridge, declined to comment on the dismissal.

Anthem Blue Cross spokesman Darrel Ng said in a statement: "Given the concerns and relative benefits and harms, our former policy applied to members in the most advanced stages of liver disease and those at highest risk for liver complications. After ongoing clinical review of the medical evidence and safety concerns surrounding hepatitis C treatments, effective January 1, 2016, Anthem revised its prior authorization criteria for employer and individual health plans to expand coverage for six of the newer oral hepatitis C treatments (Harvoni, Sovaldi, Olysio, Daklinza, Viekira Pak and Technivie), to those in all stages of liver fibrosis, with a few clinical conditions."

Hepatitis C is a viral liver infection, transmitted by blood that affects 2.7 to 3.9 million Americans and at least 130 million people globally, according to the U.S. Centers for Disease Control and Prevention and the World Health Organization.

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