Most plans consider Acthar Gel experimental and investigational for nephrotic syndrome because effectiveness for this indication has not been established.
Portland, OR (PRWEB) September 23, 2013
During a recent webinar hosted by AllMed Healthcare Management, Dr. James Wood, board-certified internist and nephrologist, gave an in-depth presentation on the use of Acthar Gel for the treatment of nephrotic syndrome. Although Acthar Gel has numerous indications and data suggest that it may be a viable treatment option for resistant nephrotic syndrome, there remains a lack of guidelines on its use.
There are numerous treatment options for patients with nephrotic syndrome, which can be caused by primary renal disease or by a variety of secondary causes. Unfortunately, many patients with nephrotic syndrome either relapse or are resistant to therapy. Physicians must often turn to second-, third-, and even fourth-line therapies to achieve remission. As new study data and novel therapies continue to emerge, utilization and case management professionals, face the challenge of providing patients with the most safe and effective, up-to-date care.
Although the indications for Acthar Gel include edematous state, to induce a diuresis or a remission of proteinuria in the nephrotic syndrome without uremia of the idiopathic type or that due to lupus erythematosus, many health plans exclude coverage of Acthar Gel for nephrotic syndrome due to limited study data. Most plans consider Acthar Gel experimental and investigational for nephrotic syndrome because effectiveness for this indication has not been established.
The current lack of guidelines on the use of Acthar Gel for nephrotic syndrome is largely due to a lack of controlled studies. The Kidney Disease Improving Global Outcomes clinical practice guidelines for glomerulonephritis, which were published in June 2012, state that the data involving Acthar Gel is of low quality. The most recent guidelines from the American College of Rheumatology for the screening, treatment, and management of lupus nephritis do not even mention the use of Acthar Gel.
Studies are ongoing to further evaluate Acthar Gel, as well as other agents, for resistant nephrotic syndrome. Because treatment and prognosis for patients with nephrotic syndrome varies widely and therapies are continually evolving, 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 in this diverse patient population.
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