Insurance Company Refuses To Pay For Hepatitis Drug That Could Save Woman’s Life

HANOVER (CBS) – A drug that could cure her Hepatitis C is available, but for 25-year-old Nichole it isn’t an option. She doesn’t have the money to cover the $83,000.00 price tag. Her insurance company, Tufts Health Plan has denied the claim four times.

Nichole was the victim of a crime and the perpetrator infected her with Hepatitis C. Since then, she has been living with fatigue, jaundice and other symptoms.

“Aside from the physical, emotionally, this has been horrible,” she said. “It’s a stigma.”

The drug is Harvoni, made by the pharmaceutical company Gilead. It has a cure rate of more than 95%. Nichole’s doctor says it is the best course of treatment.

Harvoni (WBZ-TV)

Harvoni (WBZ-TV)

“I’m 25 years old, relatively healthy and if I get treated I could live a relatively healthy life,” Nichole said.

But in the denial letters, Tufts says Nichole isn’t sick enough. It is complex medical language but clinically she must have stage 3 liver scarring or cirrhosis before they will cover the whopping cost of the medicine.

A Tufts Health Plan spokesperson said they cannot talk about the details of Nichole’s case. They issued this statement: “We have a physician-driven process designed to make sure that members receive appropriate access to medications. Any member who disagrees with a decision has the right to appeal.”

Making matters worse, the man who victimized Nichole has received the drug Harvoni in prison, paid for by the state.

Gilead, the maker of Harvoni and another Hepatitis drug, has come under fire from Massachusetts Attorney General Maura Healy. In a letter she threatens legal action unless they reconsider the price of the medication.

In a letter to the CEO, Healy writes, “Pricing the treatment in a manner that effectively allows HCV to continue spreading…results in massive public harm.”

She points to the high cost of providing the drug to prisoners and those on MassHealth as well as the gouging of consumers.

Harvoni costs $83,000 for a full course of treatment or $1000 per pill. In other countries the same drug sells for just $10 per pill.

As Nichole sees it, she’s trapped in the middle. Stuck between a drug company who wants to keep prices high and insurance companies who don’t want to pay it.

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