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Anthem Reverses Everolimus Denial Amid Affordability Concerns

10/7/2025

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Summary

Story summary

Anthem Blue Cross Blue Shield initially denied coverage for everolimus, claiming it was no longer medically necessary.
Payton Herres, 25, of Dayton, Ohio, had a heart transplant at age 11 for Ebstein’s anomaly.
Following a social-media push, Anthem reversed and approved the medication.
But copay increased substantially, pushing affordability into question; she’s exploring a new insurer amid industry concerns.

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Story summary

Anthem Blue Cross Blue Shield initially denied coverage for everolimus, claiming it was no longer medically necessary.
Payton Herres, 25, of Dayton, Ohio, had a heart transplant at age 11 for Ebstein’s anomaly.
Following a social-media push, Anthem reversed and approved the medication.
But copay increased substantially, pushing affordability into question; she’s exploring a new insurer amid industry concerns.