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Keller Rohrback Investigates Who Pockets the Rebates and Other Fees for High Priced Hepatitis C Drugs and Potential Wrongful Denial of Coverage for this Cure
According to the results of a recent congressional inquiry, Gilead Sciences Inc.—the maker of the two popular drugs for hepatitis C patients, Sovaldi and Harvoni—chose to pursue “high list prices for the drugs instead of trying to make the treatments widely available.”
The report goes on to explain that despite being “fully aware” that it would make the drug unaffordable for many patients, the company priced a 12-week course of Sovaldi and Harvoni at $84,000 and $94,500, respectively—roughly equivalent to $1,000 per pill. Conversely, Gilead sells the exact same drugs abroad for as low as $10 a pill.
In response to market pressure and public outcry over the drug’s prohibitively high prices, in February 2015, the company began to offer “discounts” on Sovaldi and Harvoni aimed at reducing the cost of those drugs by up “to 46%, on average.” Keller Rohrback is investigating whether those savings have been passed on to patients and their health plans or kept by Pharmacy Benefits Managers (“PBMs”), insurance industry middlemen who negotiate prices with drug manufacturers and oversee prescription drug plans on behalf of insurance providers and corporations.
Given the high cost of these drugs, hepatitis C patients also may not be receiving treatment to which they are entitled. Some state Medicaid programs, for example, are only providing treatment to individuals with the most severe and life-threatening conditions, despite scientifically proven evidence that there is a substantial negative health impact for any individual diagnosed with hepatitis C that does not receive treatment right away.
In May 2016 a federal judge ordered Washington state’s Medicaid provider to cover the expensive treatment for all patients with hepatitis C and not just those who are the sickest based on a fibrosis score. The wrongful denial of coverage is not just happening to Medicaid patients, but also to commercial plan patients. A New York state investigation revealed that five insurers denied 30-70% of claims and some insurers only covered patients with advance stages of the illness
If you take Sovaldi or Harvoni and are enrolled in a prescription drug plan—or if you are the sponsor of a plan offering those drugs—you may be overpaying for these medications and losing out on significant rebates offered by drug manufacturers to make the medication more affordable. If you are a patient with hepatitis C, you may also not be receiving the treatment you are entitled to under your program or insurance plan due to the high costs of these drugs.
For example, you may have been improperly told that the disease is not advanced enough to receive treatment that will be covered by your health plan. Whether you did not receive treatment at all—or went ahead and paid out of pocket for the cure to hepatitis C if you were able to do so—you may have a claim for an improper denial of coverage.
If you would like to know more or discuss Keller Rohrback’s investigation, please contact attorneys David Ko or Michael Meredith at (800) 776-6044, email , or fill out the contact form. Attorney Advertising.