MANY TREATMENT RESPONDERS FAIL BECAUSE
MEDICAID HMO CANCELS TREATMENT
Background and aims: Many Kentucky patients infected with HCV have low incomes and are covered by
Passport Medicaid HMO. This managed care company frequently denies antiviral therapy, even though
federal law prohibits Medicaid from interfering with physicians’ prescription of FDA approved medicines
(Weaver v. Reagen, No. 88-2560 UNITED STATES COURT OF APPEALS FOR THE EIGHTH CIRCUIT 886 F.2d
194; 1989 U.S. App. LEXIS 14356). The aim of this study is to determine if denial of therapy is preventing
treatment viral responders from becoming sustained viral
Medicaid HMO, denied coverage for antiviral therapy in the six-month period between 11-5-01 and 6-5-02.
The treatment and sustained response
rates were examined in this group.
fibrosis) in the six-month period noted above. One was refused treatment by Passport because of
previous treatment failure, and one was denied treatment because he is 17 years old (with cirrhosis).
Three were denied doses of Pegintron greater than 210 mcg per week, which were necessary because of
a slow response to 210 mcg per week. The others were denied treatment by their HMO after 24-48 weeks
of treatment. 21 of 26 patients were treatment responders with HCV-RNA < 1000 IU/ml, when their
medication was cancelled. Only 1 of 26 became a sustained viral responder. One patient developed HCC
and one had OLT.The remaining patients must be retreated.
treatment responders. Normally about 65% of treatment responders become sustained responders. 1 Two
thirds of the patients have severe fibrosis or cirrhosis, and are at risk of death from liver disease. One
developed HCC and
another was transplanted during this 6-month period.
therapy of military veterans: Interferon dose escalation improves the sustained response rate.