On November 11, 2015, a Medicaid recipient with Hepatitis C filed this putative class-action lawsuit in the U.S. District Court for the Southern District of Indiana. The case was assigned to District Judge Sarah Evans Barker. The plaintiff sued the Secretary of the Indiana Family and Social Services Administration (“the agency”) under 42 U.S.C. § 1983. The plaintiff, represented by the ACLU of Indiana and the Health and Human Rights Clinic at Indiana University’s McKinney School of Law, sought injunctive and monetary relief, claiming violation of federal Medicaid law.
The plaintiff alleged that the Agency had a formal policy of denying Medicaid recipients with Hepatitis C “medically necessary” drugs. Specifically, they alleged that the agency denied Medicaid recipients with Hepatitis C direct-acting antiviral medications (specifically Harvoni) unless and until absolutely necessary. Despite these practices, medical professional agreed that early administration of the medication was “medically necessary” to prevent liver damage and other serious conditions.
The defendants moved to dismiss the complaint on January 15, 2016. They alleged that the plaintiff had failed to state claim under 42 U.S.C. § 1983 for which relief could be granted. On April 12, 2016, Judge Barker denied defendants’ motion. She held that the plaintiff had sufficiently pled a claim, so she denied the defendants’ motion to dismiss the complaint.
The original plaintiff was provided with Harvoni by the agency, and consequently a new plaintiff intervened in the suit on January 3, 2017. Discovery and negotiations lasted through the remainder of 2017 and into 2018. On November 8, 2018, the parties settled the case. The settlement, contingent on the Court’s certification of the class, involved injunctive relief and attorneys’ fees for the plaintiff. As part of the settlement, the agency agreed to eliminate its policy of restricting Medicaid reimbursement for Harvoni to only those Medicaid recipients with advanced Hepatitis C or those who were co-infected with HIV or AIDS or were post-liver transplant. The defendants had to implement this policy by July 1, 2019. The defendants also agreed that they would pay the plaintiffs’ counsel $117,500 in attorneys’ fees. The agreement stated that the plaintiffs could enforce it through a breach of contract claim - meaning that the Court did not maintain jurisdiction to enforce it.
Judge Barker approved class-certification on November 9, 2018. The Court defined the certified class as:
Any and all adult Medicaid recipients in Indiana, current and future, with a diagnosis of chronic Hepatitis C, genotype 1, who have been prescribed one of the direct-acting antiviral medications enumerated in the 2016 Policy or 2018 Policy, by or in consultation with an Infectious Disease or GI specialist, but do not meet the medical requirements of such policy to receive Medicaid reimbursement for that prescribed medication.
On November 26, 2018, Judge Barker approved the parties’ joint motion regarding the manner and form of notice to the class. A class-action fairness hearing was held on February 5, 2019. At this hearing, the court approved the settlement agreement and the attorney fee request. One week later, the court issued a written order confirming the oral order from the hearing where the court approved the settlement agreement, and found that it was a fair, reasonable, and adequate resolution of the cause.
With the settlement agreement approved, on February 20, 2019, the parties filed a stipulation of dismissal. Six days later, the court dismissed the case pursuant to Rule 41(a) (1)(A)(ii) of the Federal Rules of Civil Procedure. The case is now closed.
Michael Beech - 02/02/2019
Sabrina Glavota - 07/13/2020
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