Woman suing insurer after being denied access to ovarian cancer drug

Robin Chusid said she knew something was wrong for months, but after several doctor visits she still didn't know what it was.

"Eventually, I had to ask my gynecologist for a sonogram, and then he discovered, you know, the tumor in my ovaries, and, sadly, it was already spread," Chusid said.

In May 2016, she was diagnosed with stage 4 ovarian cancer, which had already spread to her colon and liver.

Chusid said that when she heard she had stage 4 cancer, she thought she'd die.

"That's what I thought," Chusid said.

Chusid underwent surgery and finished chemotherapy just one week before her son's wedding.

She said dancing with him that night was one of the best moments of her life.

But the anxiety of worrying about the cancer coming back was crippling.

 Ovarian cancer is known to be especially deadly and relapses are common.

"I said, 'Oh, my God …Who knows how much time I have left?' I'm going to get it back," Chusid said.

She then learned about a new drug called Zejula, which was approved by the FDA in March for women who have had a relapse or are in remission from ovarian cancer.

Chusid's husband, attorney Mitch Chusid, followed the clinical trials for Zejula closely.

"(About) 75 percent of the women who had the recurrent ovarian cancer were cancer-free," Mitch Chusid said. 

There was new hope as the drug got the green light.

"I felt like my life was going to be saved. This is going to prevent it coming back," Robin Chusid said. "And then I was denied, and we appealed it, and I was denied again."

The cost of the pills is more than $15,000 a month.  

Robin Chusid's doctor wrote to her insurance company, Blue Cross Blue Shield.

In the letter, marked urgent, the doctor writes, "Robin Chusid has a diagnosis of ovarian cancer and needs treatment with Zejula ... In my professional opinion, Zejula is medically necessary."

"It's like somebody was playing God, saying, 'Sorry, there it is, you know, there's the pill (that) can save your life, but, you know, we don't want to pay for it yet,'" Robin Chusid said.

The Chusids said the reason Blue Cross Blue Shield gave them for denying coverage is because Zejula is not currently in the list of drugs the company covers.

It's not clear if that could change after a six-month review period is complete.

A spokesman for Blue Cross Blue Shield Florida gave a statement to Local 10 News.

"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.

The company typically has a review process for a new drug on the market, but that can take about six months.

"They don't know me, so I'm faceless to them, and every woman out there is faceless," Robin Chusid said.

The Chusids filed a class-action lawsuit against Blue Cross Blue Shield on behalf of all women diagnosed with ovarian cancer and insured by the company.

In the meantime, Zejula's manufacturer has provided Robin Chusid with a limited supply of the drug, but she knows it's temporary and worries about other women fighting the same battle.

"If one person lives, that's what matters," she said.

This BBSNews article was syndicated from News | WPLG, and written by News | WPLG. Read the original article here.