In:
American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 114, No. 1 ( 2019-10), p. S588-S588
Abstract:
Approved HCV DAA regimens can cure nearly all patients; however, barriers to care in community practices include patients with a large number of medical co-morbidities, advanced liver damage and insurance approval of DAA regimens. This study assesses medical conditions, liver staging methods, and the drug prior auth process in HCV-infected patients managed in community practices partnered with a dedicated pharmacy team with expertise in liver disorders. METHODS: This IRB-approved, ongoing study captures outcomes on a cohort of 705 patients from community practices across Texas. Patients had chronic hepatitis C and were treated with DAA regimens selected by the physician. Insurance carrier and prior auth process data were also captured. RESULTS: 96% of prior auth requests to Medicare and Medicaid were accepted upon first request; however, only 84% of requests to private insurance were accepted upon first request and did not require an appeal. This cohort included many patients with complicated medical histories including HCC (4.4%), ESRD (2.7%), liver transplant (2.1%) and seizure disorders (4.5%). Liver staging was done via Fibrotest (71%), Fibroscan (22%), Fibrosure (13%) and liver biopsy (0.6%). Medicaid patients had proportionately more advanced disease (79% F3/F4) and were less likely to be previously treated with DAA therapy (1.6%). The most common co-morbid conditions were hypertension (66%), diabetes (28%), GERD (23%), depression (20%), anxiety (16%) dyslipidemia (16%), renal disease (9%) and COPD (9%). Medicaid patients had the highest rates of dyslipidemia, obesity, renal disease and COPD. Overall, 90% of patients had undetectable virus at week 4, 96.7% completed follow-up and 97% achieved SVR, regardless of health insurance type. All patients with ESRD or with seizure disorders treated with oxcarbazepine achieved SVR as did 87% of patients with prior liver transplant. SVR was also achieved in 86% of patients with a history of HCC. CONCLUSION: HCV treatment in the community setting resulted in 97% cure. This cohort includes a wide variety of patients including those on dialysis or post-liver transplant. Partnership with a dedicated and liver focused pharmacy team resulted in 90% approval of first-time prior auth requests. Knowledge of and management of co-morbid conditions is critical for maximizing overall patient adherence, compliance and outcomes. Close monitoring through a chronic care management model can lead to better overall patient management.
Type of Medium:
Online Resource
ISSN:
0002-9270
,
1572-0241
DOI:
10.14309/01.ajg.0000593640.13968.36
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
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