Local woman sues Anthem Blue Cross for denying Hepatitis C drug

LOS ANGELES (KABC) -- A Los Angeles woman is suing Anthem Blue Cross claiming the insurance company is denying her coverage for a Hepatitis C drug that could cure her.

Jane Blumenfeld said it has been 14 years of fear and uncertainty since she was diagnosed with Hepatitis C. She does not know when her health could take a turn for the worst.

It all started when she tried to donate blood.

"The next day they called me at work and said, 'I think you have Hepatitis C.' It was literally out of the blue," she said.

There is a new drug called Harvoni, which is effective at curing Hepatitis C, but Anthem has denied her treatment.

In a letter, Anthem said it is not medically necessary because Blumenfeld is not sick enough to receive the medication.

Anthem also said it might approve the medicine if Blumenfeld has advanced scarring in her liver. She has to be stage 3 or higher, according to her attorney, Ricardo Echeverria.

He believes it is all because of the cost of the drug. For 12 weeks of treatment, Harvoni costs $94,000.

"If you wait until stage 3, or God forbid stage 4 when you've got scarring on your liver, the Harvoni may still cure the disease, but it's not going to cure the scarring. That puts you at an increased risk for liver cancer," Echeverria said.

Dr. Peter Ruane uses a fibroscan to determine what stage the person's liver has progressed. He said there are a lot of people with Hepatitis C and treating them all at once would be expensive and difficult to do.

"Hepatitis C progresses slowly. In general, it takes 20 to 30 years plus for someone to go from initial infection to cirrhosis," he said.

Blumenfeld feels it is a ticking time bomb. She might get the treatment if the disease gets worse, and she does not know if by then it might be too late.

"Whether it ramps up quickly or slowly, or you get something tomorrow and you all of the sudden have liver cancer - these are the things that are so horrible to live with," she said.
Copyright © 2020 KABC-TV. All Rights Reserved.