Attorney Mitchel Chusid and his wife, Robin. (J. Albert Diaz)
Robin Chusid, 55, fought cancer for about a year. She seemed to have won, and danced at her son’s wedding one week after her last chemotherapy treatment in October.
But Chusid said she’s always afraid. Ovarian cancer recurs in 70 percent of women in remission, according to data from the nonprofit Ovarian Cancer Research Fund Alliance. The odds, she said, seem stacked against her.
Now the wife of Coral Springs litigator Mitchel Chusid is gearing for another fight, this time with Blue Cross and Blue Shield of Florida Inc. for denying coverage of a $15,600-per-month drug. Her husband’s 40-page class action lawsuit filed June 13 in Broward Circuit Court includes medical records and asks the court for two things: a finding that the insurance company violated Florida’s Deceptive and Unfair Trade Practices Act and a declaration forcing Blue Cross to cover a drug called Zejula, which the Food and Drug Administration approved in March to treat relapsed ovarian cancer patients and those in remission.
“For Blue Cross to say they’re not paying for it because it’s not in their formulary, they’re playing god,” Mitchel Chusid said. “They have control over medication that could save people’s lives, and they’re saying, ‘We’re not paying for it.’”
No attorney had entered an appearance for Florida Blue Cross by press time, and assistant general counsel Jeremy Ches did not respond to a request for comment by deadline.
But insurance sources say it can take up to six months from the date of FDA approval for companies to review a drug’s efficacy and determine how to cover it before adding it to their policies.
“Florida Blue takes any member complaint very seriously and we are looking into the situation,” spokesman Doug Bartel said. “While we do not comment on matters involving a specific customer, the health and well-being of all our members is of utmost concern.”
But the Chusids believe otherwise.
“I believe Blue Cross has taken this position solely for monetary reasons,” Mitchel Chusid said.
“As we speak I know of four other insurance companies—Medicare, Aetna, United Healthcare and Preferred Partners—that have approved Zejula and are paying at least in part for it.”
Coral Springs-based Ritter Chusid pays more than $15,000 per month in premiums for employer-based insurance plans that cost $580 or about $1,700 monthly for individual and family coverage, respectively, Mitchel Chusid said.
The attorney said Florida Blue denied a request from his wife’s physician and also turned down a written appeal. He said he spent nearly three weeks making calls to the insurer and its general counsel before filing suit over the $15,600-per-month, or about $173-per-pill, drug by Massachusetts-based manufacturer Tesaro Inc.
Zejula is a poly ADP-ribose polymerase inhibitor. It slows tumor growth by blocking an enzyme that allows cancerous cells to repair themselves, according to the FDA.
“I felt I was saved,” Robin Chusid said. “I thought, ‘This is going to save my life.’ The FDA approved it. We thought it would be as simple as sending it through Blue Cross Blue Shield.”
The proposed class would consist of Blue Cross members in remission or relapse from ovarian cancer. The suit claims the company reneged on its pharmacy agreement by denying Robin Chusid coverage of an FDA-approved drug deemed medically necessary by her physician.
“I have a husband who is working so hard to try to get (the medication) for me. There are women who stop after day one,” she said. “He’s been calling all the way up the ladder. I wouldn’t have known to do that. I would have been waiting for the next time I got ovarian cancer.”