Miami Judge Orders Oscar Health to Cover Cancer Patient's $48K Drug, Setting Precedent for Insurance Disputes
A Miami-Dade judge has ruled that Oscar Health Insurance must cover a $48,500 oral medication for a Stage 4 pancreatic cancer patient, Pablo Langesfeld. The dispute began when Langesfeld's doctor prescribed the drug Avmapki Fakzynja Co Pack after chemotherapy failed. Oscar Health denied coverage, citing the drug's lack of federal approval for pancreatic cancer. However, the drug is FDA-approved for ovarian cancer and has an 'orphan drug' designation for pancreatic cancer research. Judge Migna Sanchez-Llorens found Oscar Health's policy definitions ambiguous, ruling in favor of the patient as required by Florida law. 
