Employee Benefits News examines legal developments that impact the employee benefits and executive compensation employers provide, including federal and state legislation, rules from federal...
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.
To contact the reporter on this story: Jacklyn Wille in Washington at firstname.lastname@example.org
To contact the editor responsible for this story: Jo-el J. Meyer at email@example.com
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.
Copyright © 2016 The Bureau of National Affairs, Inc. All Rights Reserved.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to firstname.lastname@example.org.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to email@example.com.
Put me on standing order
Notify me when new releases are available (no standing order will be created)