Heart transplant survivor battles insurer denial, finds relief through Mark Cuban's pharmacy

Payton Herres received a donor heart at age 11 after being born with the rare Ebstein’s anomaly. Her long-term survival depends on a combination of everolimus and cyclosporine, a regimen prescribed by Cincinnati Children's Hospital Medical Center following previous rejections of alternative drugs. In February, Anthem notified her that everolimus was “no longer medically necessary,” leading to a denial of coverage and a steep rise in her copay from about $180 to $350 per month for a 30-day supply.

Her attempts to appeal failed, and she turned to social media to draw attention to the issue. The viral posts reached Mark Cuban, whose Cost Plus Drug Company stepped in, offering the drug for roughly $300 per 90-day supply, with a nonprofit covering additional costs. While GoodRx coupons temporarily lowered the price further, their reliability remains uncertain. Herres' struggle reflects a broader pattern of insurers denying specialty medications, affecting many patients nationwide.