Class Action: Centene Corp. Subsidiary Only Covers Hep C Cure In Cases of ‘Severe, Irreparable’ Liver Damage

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Centene Corporation, Inc. and Centene Management Company, LLC are the defendants in a proposed class action lawsuit filed by three unnamed plaintiffs who allege Celtic Insurance Company, a subsidiary of the defendants, has acted unlawfully in refusing to cover hepatitis C treatments.

The suit explains Centene, with more than 40 subsidiaries, is a major player in the multi-state marketplace for health insurance policies created by the Patient Protection and Affordable Care Act (ACA). In what the lawsuit describes as a scheme to avoid paying for hep C drugs, the defendants have allegedly instructed Celtic Insurance to refuse to pay for supposedly breakthrough treatments that cure hepatitis C unless an insured individual has already suffered “severe, irreparable liver damage.”

“This conduct constitutes tortious interference with the uniform contractual promise in those health insurance policies to provide coverage, and pay for, medically necessary treatment,” the plaintiffs argue.

No cure existed for hepatitis C until 2014, the lawsuit notes. Before then, afflicted individuals reportedly had to undergo extensive, costly treatments consisting of daily pills and weekly injections coupled with debilitating side effects and no guarantee of a cure. Since October 2014, the case continues, direct-acting antiviral drug (DAA) treatments with cure rates of between 94 and 100 percent with little to no side effects have been on the market and touted by the FDA as a “breakthrough”—pills one need only take for eight to 12 weeks depending on severity.

According to the lawsuit, once the first DAAs hit the market, certain health insurers immediately began scheming on how to avoid paying for the treatments.  Such schemes, the suit claims, were “designed to save money and force insureds to wait until the disease had caused them to suffer irreparable liver damage” or switch insurance policies. This conduct is not unlike that of the defendants’, the plaintiffs say, adding that because of the companies’ policies, “80 [percent] of hepatitis C sufferers” must wait until it may be too late to receive covered treatment.