Readers React: Insurer won’t cover a drug? Report it to the state.

My Patient Rights | Stay Informed | Readers React: Insurer won’t cover a drug? Report it to the state.

Readers React: Insurer won’t cover a drug? Report it to the state.

To the editor: Patient Jane Blumenfeld’s lawsuit over Anthem Blue Cross’ refusal to pay for the outrageously expensive hepatitis C drug Harvoni may result in her getting the drug in a year or two. (“High cost of hepatitis drug reflects a broken pricing system,” June 19)

But she can appeal Anthem’s decision to the California Department of Managed Health Care, which would make its decision within 30 days after getting her medical records. It refers the matter to three doctors (specialists who remain anonymous), who decide if the treatment is more beneficial than the alternatives.

When Anthem refused to authorize Harvoni for my hepatitis C because I was not yet at death’s door, I appealed to that department, which ruled in my favor in 30 days. The insurer, which cannot appeal, was ordered to authorize the Harvoni within five business days. After taking the drug for eight weeks, I was cured.

Some say, “I don’t want the government coming between my doctor and me.” I don’t want a greedy drug maker or an insurance company coming between us.

Bruce Janger, Santa Monica

Read more: http://www.latimes.com/opinion/readersreact/la-le-0624-wednesday-drug-prices-20150624-story.html

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