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June 22 — Florida Blue agreed to cover a life-saving hepatitis C treatment for up to 2,000 insured individuals, a move the insurer claims will cost about $126 million ( Oakes v. Blue Cross & Blue Shield of Fla., Inc. , S.D. Fla., No. 9:16-cv-80028-RLR, preliminary approval order 6/21/16 ).
The agreement settles a proposed class action accusing the insurer of operating an unlawful scheme to deny coverage for the “miracle drug” Harvoni, which allegedly cures 95 percent of hepatitis C cases within eight weeks and carries a price tag of $63,000 for the eight-week treatment. A Florida-based federal judge gave the settlement preliminary approval on Tuesday.
Florida Blue, formally known as Blue Cross & Blue Shield of Florida Inc., isn't the only insurer in the cross-hairs of a lawsuit over Harvoni coverage. A California plaintiffs' company recently filed similar class actions against Blue Shield of California, Anthem Blue Cross Life and Health Insurance Co. and UnitedHealthcare Insurance Co.
A separate proposed class action challenged Florida Blue's failure to cover Harvoni under contract law and the Racketeer Influenced and Corrupt Organizations Act. The insurer persuaded a federal judge to dismiss that lawsuit in May.
The settlement is intended to apply to participants in two types of Florida Blue health plans: employer-sponsored plans governed by the Employee Retirement Income Security Act and plans not subject to ERISA's requirements. The lawsuit originally involved only ERISA plans, but participants asked the court for permission to file a new complaint that would expand the settlement to non-ERISA plan participants.
According to the agreement, Florida Blue also vowed to lift a coverage restriction in its health plans that would allow future patients expanded access to Harvoni.
The agreement allows the participants' lawyers to seek attorneys' fees of more than $2.2 million.
Judge Robin L. Rosenberg of the U.S. District Court for the Southern District of Florida granted preliminary approval of the settlement on June 21.
Rivero Mestre represents the participants. McDermott Will & Emery represents Florida Blue.
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Text of the preliminary approval order is at http://www.bloomberglaw.com/public/document/Oakes_v_Blue_Cross__Blue_Shield_of_Florida_Inc_Docket_No_916cv800.
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