Segment 6 - Screening and Appropriate Diagnosing in Hepatitis Treatment

Dr Fendrick urges the panel to discuss which tools involving benefit design are being put into place to make sure that only those patients who would benefit most from new drugs are receiving them.

Dr Fendrick urges the panel to discuss which tools involving benefit design are being put into place to make sure that only those patients who would benefit most from new drugs are receiving them.

“We’re dealing with progressive disease, and we don’t want to deny anyone any treatment that might prevent severe disease in the future,” says Dr Winston. He adds that some people can be staged through new screening and tools. He says the Food and Drug Administration, for instance, recently approved FiberScan, which gauges the severity of cirrhosis. Such tools are a more cost-effective way for people to get staged.

“You need to just talk to the patient. They may have very mild disease, you may be able to watch them for a while,” Dr Winston says. “Certainly anyone with more advanced disease—[like] fibrosis—you really want to get those people treated now.”

Dr Fendrick asks Dr Winston if organizations like Cigna are using any levers with clients to make sure that the first time a primary care physician sees a claim for these “blockbuster” (high cost) drugs, that they’re seeing the appropriate patients, and that they don’t have to worry about screening. Dr Winston suggests that as treatment evolves, everyone should be eligible to receive new 1-pill treatments because eventually, older treatments such as interferon will disappear.

Dr Miller points out that such important health interventions often come at a cost. He thinks that they will be managed like many other drugs. New therapies will become easier and easier to use as people become more comfortable with them. However, providers have to make sure they go through the screening process so patients are given appropriate treatments.

He adds that prior authorization, genotyping, and additional testing will ensure appropriate response to drug regimens. Other management strategies, like quantity limits, will also assure that patients are tolerating therapy regimens.