PALM BEACH COUNTY/HILLSBOROUGH COUNTY, Fla.- Charles Riggins received some startling news in January of 2005 when he was given a diagnosis of chronic myelogenous leukemia (CML). Mr. Riggins' physicians prescribed the medication Gleevec to control the disease and to prevent it from becoming more active and attacking his vital organs. Humana, Mr. Riggins' healthcare provider approved the treatment. Gleevac was initially approved by the FDA in 2001 to treat CML patients in which Interferon, a widely used drug, had failed. Gleevac in patients with CML not only stops the progression of the disease but also significantly reduces the number of cancerous cells. Gleevac also achieves the desired results with a minimum amount of side effects that are commonly seen with other generic CML medications such as Hydrea.
During the first 12 months of treatment with Gleevac, Charles Riggins responded well. Furthermore, Humana paid for the treatment, only requiring the patient to pay a $40 co-pay for medication. Mr. Riggins' physicians noted that his white blood cell count remained low and his leukemia remained under control on Gleevec.
In December of 2005 without notice Humana changed Gleevac from a level 4 to level 5 drug and suddenly stopped paying for Mr. Riggins' medications. They demanded a $700 per treatment co-pay. He tried to obtain his prescriptions on several occasions and on all occasions Humana denied the requests. Mr. Riggins and his family were unable to afford the $700 co-pay, thus from December 15, 2005 through October 29, 2007 he went without treatment. His doctor noted that his condition was deteriorating and that the leukemia was active and he absolutely needed the Gleevac. Humana still said "no" unless Mr. Riggins would pay the $700. Mr. Riggins' doctor was forced to put him on the generic drug Hydrea, which Humana would authorize for $50.41 per month; however by January 2007 it was realized this medication had no positive impact on his condition and he continued downhill.
Mr. Riggins continued to deteriorate through October 2007. Humana finally decided to re-authorized Gleevac for him, but by this time he was hospitalized and the medication was no longer beneficial. To add insult to injury, Human refused to authorize payment during this time for the services of several of Mr. Riggins' treating physicians due to the fact there was no pre-approval for "in patient services."
"Despite receiving information from Mr. Riggins and his physicians that Gleevac was necessary to control his leukemia and allow him to maintain his life, Humana refused to cover the cost for 22 months. After stopping on Gleevac his health deteriorated and he passed away. They are to be held responsible for this egregious behavior and disdain for his well being and medical treatment," said consumer justice attorney Theodore (Ted) Leopold of the Palm Beach Gardens-based law firm Leopold Law, P.A. Mr. Leopold is representing Charles Riggins' family in the suit which includes seeking justice for the family. "Humana was advised on countless occasions by medical professionals that Charles Riggins' Gleevac was necessary in order to control his leukemia yet, despite initially covering the drug, they later refused to authorize the drug because it cost this company to much money. They knew he was unable to pay on his own, they knew his health was deteriorating, they knew the generic drug was not effective and they knew he would lose his life to this disease without treatment, yet they refused to pay," he continued.
"This firm will fight for justice for Charles Riggins and his family and send a loud and clear message that we will hold companies like Humana accountable for this type of behavior and for not putting consumers that they insure and their lives ahead of profits. The Riggins case is representative of how all managed care companies act and treat their insureds. We will fight for justice for all consumers and not just for the Riggins family," Mr. Leopold added with great compassion.