Heart transplant survivor fights to keep access to anti-rejection drug
At 11, Payton Herres received a donated heart after years of health problems caused by Ebstein’s anomaly. Fifteen years later, she faced a fight to access everolimus, the anti-rejection medicine she had relied on since 2013. After her insurer stopped covering the drug and its cost rose sharply, Herres turned to social media. Her story went viral and reached Mark Cuban, whose pharmacy began…
Payton Herres received her first heart transplant at the age of 11 in 2012 after being born with Ebstein’s anomaly, a rare congenital heart condition. She had been a successful recipient of the transplant, but was later faced with a dispute with her health insurer regarding the cost of her anti-rejection medication, everolimus. The insurer stopped covering the drug, which Herres had been taking since 2013 to prevent organ rejection.
Despite her efforts, including reaching out to billionaire Mark Cuban, her insurer continued to deny her requests. Her situation drew attention when her story went viral online, prompting Anthem to review her case. The original decision was based on medical guidelines that did not fully reflect her treatment history, and the insurer apologized.
However, the cost of the medication increased significantly, from $180 to $1,000 for a 90-day supply. Herres found some relief through GoodRx coupons, which reduced the price to $88.66 for a 30-day supply, but these were not always reliable. Billionaire Mark Cuban intervened by offering to pay for her medication, which is now supplied by Mark Cuban's pharmacy for $300 for 90 days, with a nonprofit covering the costs.
Her story highlights the broader issue of health insurance coverage in the US, with studies showing that 70% of commercially insured patients had at least one prescription initially denied in 2024, with 25% still unable to gain approval after a year.
Written by urgent.news from Times of India's reporting — not their text. Machine-written — may contain errors; check the original before relying on it.
