Sadistic Anthem Blue Cross refuses to allow California hepatitis C patient to be cured of disease

Imagine being struck with a truly horrible disease -- perhaps hepatitis C -- and there is a cure available. A really good cure. What some might describe as a "miracle" of modern medicine. But, wait for it, then you are told by some faceless bureaucrats at a for-profit health insurer that you are not sick enough for that cure -- first, you must get more sick, suffer more, have your body collapse more before you are eligible for the cure. Imagine the mental anguish. Imagine the mental -- not hyperbole to employ this diction -- torture.

This, my friends, is what West Hollywood resident Shima Andre faces -- this is her life.

Here are the basic facts courtesy of the Los Angeles Times.

A West Hollywood woman sued insurer Anthem Blue Cross for refusing to cover the cost of an expensive drug that she says would cure her hepatitis C infection.

Shima Andre said in the lawsuit that Anthem has refused to pay the estimated $99,000 it would cost to be treated with the controversial drug Harvoni, which has been shown to destroy the deadly virus in most patients.

In a denial letter, Anthem explained that the drug was “not medically necessary” because Andre does not have advanced liver damage, the lawsuit said.

“We may approve Harvoni when the liver has a certain amount of scarring on a liver biopsy,” the insurer explained. “Records we received do not show that your liver has this amount of scarring.”

Andre, 42, who was diagnosed with hepatitis C in 2011, said she was thrilled when the Food and Drug Administration approved the drug last year. But she hasn't been able to take it because Anthem declined to cover the cost. She said she has postponed becoming pregnant because she fears she would pass along the virus to her child.

Yes, imagine being told by an Anthem (formerly known as WellPoint) Blue Cross bureaucrat -- the same insurer that retroactively denied cancer care to breast cancer patients (a practice so barbaric that President Obama called them out by name) -- that your liver simply does not have a sufficient "amount of scarring" to qualify for coverage of the drug that would change your entire life. In the case of Ms. Andre, being cured from the disease would also allow her to become pregnant.

Andre, 42, who was diagnosed with hepatitis C in 2011, said she was thrilled when the Food and Drug Administration approved the drug last year. But she hasn't been able to take it because Anthem declined to cover the cost. She said she has postponed becoming pregnant because she fears she would pass along the virus to her child.

Ms. Andre's story brings tears to my eye. Anthem Blue Cross is not only denying her the chance to live a normal, healthy life, but also the chance to have a normal, healthy baby -- without fear of the baby contracting a terrible disease.

Yes, my friends, this drug -- Harvoni -- is good. This is not a case of a drug that may or may not work. Look at the record.

Harvoni is a pill taken once a day for eight to 12 weeks that has been proved in clinical testing to wipe out the virus in more than 90% of patients, without significant side effects.

Of course, however, because the drug is so amazing, it is also expensive. Really expensive. Curing Ms. Andre would cost about $99,000 and, as a big-profit corporate insurer, Anthem has shareholders to please.

Let's unpack this Anthem abuse below the fold.