![\"Pablo](\"https:\/\/www.newsbeep.com\/us-fl\/wp-content\/uploads\/2026\/04\/1777081691_447_MIA_01CANCERPATIENTTREATMENTDENIED.JPG\" "\\"Pablo")
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Pablo Langesfeld, left, stands with his son Martin, right, outside the Osvaldo N. Soto Miami-Dade Justice Center in Miami on Tuesday, April 7, 2026. Langesfeld, who is battling advanced pancreatic cancer, won a lawsuit he filed against Oscar Health Insurance. The health insurer will now need to cover a drug therapy his doctor recommended.<\/p>\n
Carl Juste<\/p>\n
cjuste@miamiherald.com<\/p>\n
A Miami-Dade Circuit Court judge has ruled in favor of a cancer patient whose health insurer refused to cover a recurring $48,500 cancer treatment<\/a> that could save his life.<\/p>\n Thursday\u2019s ruling is a win for Doral resident Pablo Langesfeld, who has been in a back-and-forth with Oscar Health for months over the potentially lifesaving medication.<\/p>\n \u201cWe are very grateful for the outcome of this case. Our focus remains on my father\u2019s health and ensuring he receives the care his doctors recommend,\u201d Martin Langesfeld, Pablo\u2019s son, told the Miami Herald in a text message shortly after the ruling. \u201cNo person should ever have to fight this hard to simply get the medical care they need.\u201d<\/p>\n Circuit Court Judge Migna Sanchez-Llorens in her ruling described parts of Oscar Health\u2019s policy, including its definition of \u201cmedically necessary,\u201d as ambiguous, noting that Florida law requires ambiguous insurance contracts to be interpreted in favor of the customer, which in this case is Langesfeld. She ordered the health insurer to authorize and provide coverage for Langesfeld\u2019s prescribed oral medication.<\/p>\n The verdict is a \u201cbig win for patients\u201d who may find themselves in similar situations, Maria T. Santi of Health and Medicine Law Firm, one of Langesfeld\u2019s attorneys, told the Herald.<\/p>\n Oscar Health did not immediately respond to a request for comment.<\/p>\n The medication<\/p>\n The dispute began in December, when Langesfeld\u2019s in-network physician, Dr. Peter Hosein at Sylvester Comprehensive Cancer Center in Miami, prescribed him Avmapki Fakzynja Co Pack, an oral medication, \u201cdue to failed chemotherapy interventions\u201d against his Stage 4 pancreatic cancer. The drug therapy is approved by the U.S. Food and Drug Administration to be used for ovarian cancer treatment and was granted an \u201corphan drug\u201d<\/a> designation in 2024 to encourage research and testing against pancreatic cancer, the third-leading cause of cancer-related death in the country.<\/p>\n The therapy has shown promise in trial results against metastatic pancreatic cancer. While Oscar approved coverage for Langesfeld\u2019s chemotherapy, it refused to pay for the costly oral medication \u2014 which comes with a price tag of $48,500, every three weeks \u2014 arguing in court that the oral medication is \u201cexperimental,\u201d not medically necessary and not federally approved to treat his cancer. Langesfeld\u2019s attorneys sued, accusing Oscar Health of violating its own insurance policies.<\/p>\n Now, Langesfeld\u2019s battle is over, and he\u2019ll be able to add the drug therapy combo to his treatment regime.<\/p>\n \u201cThis has been a very stressful and challenging experience for me and my family,\u201d Langesfeld told the Herald. \u201cManaging my health while dealing with this process has been extremely difficult.\u201d<\/p>\n Langesfeld\u2019s family and his attorneys also see it as a win for frustrated patients who find themselves in a never-ending dispute with health insurers over off-label drug coverage.<\/p>\n \u201cDoctors are being overshadowed by health insurances\u201d who are \u201ctrying to dictate medical care for patients,\u201d Santi said.<\/p>\n \u201cThe doctor knows what is right for his patients, not the health insurance,\u201d she added, describing Thursday\u2019s ruling as one that \u201cwill open the door\u201d and likely lead to more patients getting their prescribed off-label drug covered.<\/p>\n The judge\u2019s decision comes several weeks after the jury ruled in favor of Langesfeld, answering \u201cyes\u201d on four out of five questions related to whether the prescribed drug therapy is appropriate to treat his aggressive cancer.<\/p>\n \u201cWe are so gratified that the Judge and Jury carefully considered the important issues in this case and came to the correct and inevitable conclusion that Pablo is entitled to the drugs he needs,\u201d attorney Todd Legon of Coral Gables-based Legon Fodiman and Sudduth, who represented Langesfeld alongside Santi, said in a statement. \u201cJustice has been served not only for Pablo but for the countless others whose insurance companies deny coverage without justification every day.\u201d<\/p>\n This is not the first time Oscar Health has been taken to court over policy violations. A federal judge in Texas ruled in favor of the New York-headquartered insurer earlier this year and dismissed a class action lawsuit<\/a> that accused Oscar of violating state law and its own policies by requiring policyholders to pay deductibles and coinsurance for diagnostic breast imaging. An appeal has since been filed in the Texas case challenging the court\u2019s decision.<\/p>\n This story was originally published April 23, 2026 at 7:00 PM.<\/p>\n Michelle Marchante<\/a><\/p>\n Miami Herald<\/p>\n Michelle Marchante covers the pulse of healthcare in South Florida and also the City of Coral Gables. Before that, she covered the COVID-19 pandemic, hurricanes, crime, education, entertainment and other topics in South Florida for the Herald as a breaking news reporter. She recently won first place in the health reporting category in the 2025 Sunshine State Awards for her coverage of Steward Health\u2019s bankruptcy. An investigative series about the abrupt closure of a Miami heart transplant program led Michelle and her colleagues to be recognized as finalists in two 2024 Florida Sunshine State Award categories. She also won second place in the 73rd annual Green Eyeshade Awards for her consumer-focused healthcare stories and was part of the team of reporters who won a 2022 Pulitzer Prize for the Miami Herald\u2019s breaking news coverage of the Surfside building collapse. Michelle graduated with honors from Florida International University and was a 2025 National Press Foundation Covering Workplace Mental Health fellow and a 2020-2021 Poynter-Koch Media & Journalism fellow.\u00a0
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