Although many health plans cover the use of the new viral protease inhibitors for HCV, patients must meet very stringent criteria due to the complexity of triple combination therapy that includes these drugs.
Portland, OR (PRWEB) November 26, 2013
As the treatment of HCV continues to evolve, new and increasingly complex protocols present additional challenges in providing optimal care while meeting the unique needs of individual patients with HCV. During a recent webinar hosted by AllMed Healthcare Management, Dr. Anca Pop, board-certified gastroenterologist and internist, gave an in-depth presentation on the latest in the standard of care for the treatment of hepatitis C virus (HCV) infection.
For the past decade, chronic HCV infection has been treated with PEG-IFN plus ribavirin. A shift in this standard of care occurred with the relatively recent approval of the viral protease inhibitors boceprevir and telaprevir, which must be used in combination with PEG-IFN plus ribavirin. Both protease inhibitors substantially improve rates of sustained virological response in patients who have had previous treatment, as well as in those who have not.
Although many health plans cover the use of the new viral protease inhibitors for HCV, patients must meet very stringent criteria due to the complexity of triple combination therapy that includes these drugs. Patients receiving HCV treatment should be monitored regularly for treatment-related side effects, adherence to therapy, and response to therapy. Thorough clinical documentation, including failure of any prior therapies, is required to support medical necessity of triple combination therapy for HCV.
The major recommendations from the most recent update to the American Association for the Study of Liver Diseases (AASLD) practice guideline for HCV treatment covers optimal therapy for treatment-naïve patients, re-treatment with boceprevir or telaprevir (together with PEG-IFN and ribavirin), management of side effects associated with viral protease inhibitors, and predicting and monitoring response to therapy.
The determination of medical necessity for HCV treatments has become increasingly complex in recent years, and this trend will continue as new combinations and classes of drugs are studied more extensively. The first drug in a new class known as nucleotide analogue inhibitors will likely be approved in December 2013, and all-oral and interferon-free treatment regimens are also in the pipeline.
The standard of care for HCV is likely to shift again in the not-so-distant future, and it is essential for healthcare plans to position themselves to be able to make timely updates to their coverage criteria and medical policies in order to optimize care and treatment outcomes as additional drugs are being studied to improve side-effect profiles and dosing schedules and to deal with resistance issues.
AllMed Healthcare Management provides physician review outsourcing solutions to leading health plans, medical management organizations, TPAs and integrated health systems, nationwide. AllMed offers MedReview(sm), MedCert(sm), and MedDirector(sm) staffing services that cover initial pre-authorizations and both internal and external appeals, drawing on a panel of over 400 board-certified specialists in all areas of medicine. Services are deployed through PeerPoint(R), AllMed's state-of-the-art medical review portal. For more information on how AllMed can help your organization improve the quality and integrity of healthcare, contact us today at info(at)allmedmd(dot)com, or visit us at http://www.allmedmd.com.