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 responders.

Methods: We retrospectively examined the charts of the patients with insurance coverage by Passport

 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.

Results: Passport Medicaid HMO denied antiviral therapy to 26 patients (17 with cirrhosis or severe liver

 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.

Conclusion: Refusal of antiviral treatment by Passport HMO Medicaid caused treatment failure in 20 of 21

 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.

1. Poster Presentation AASLD 2001 Dallas Texas. Bennet Cecil, Mary Lavelle. Individualized hepatitis C

 therapy of military veterans: Interferon dose escalation improves the sustained response rate.