Hep C Discussion Forum

As we know the AASLD guidelines established a basis for who and when to treat.  Despite the AASLD's subsequent statement that the guidelines were not intended to be used to deny tx the guidelines do in fact clearly set forth a type of rationing system.  If you are wondering how docs in clinical practice are interpreting and applying the guidelines have a look at this doctor's take on it:

http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20Guidance/Clinical%20Thoughts/CT%202.aspx

HCV Treatment Eligibility and Access
Current guidance from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) has recently further emphasized that all patients with chronic HCV infection should be considered as candidates for HCV therapy. However, the guidance also recognizes that medical resources are often limited, preventing complete treatment coverage for all infected patients. In the setting of resource constraints, the guidance recommends prioritizing patients for treatment based on their stage of disease or risk of progression. In addition to general medical resource constraints, insurance coverage is also proving to be a challenge for initiating HCV therapy with newly approved, costly regimens in the US, particularly for patients who do not have evidence of advanced liver disease. Since the approval of simeprevir and sofosbuvir, many clinicians have found that insurance companies have denied coverage for these new treatments in patients with early-stage disease. Thus, my first step with any patient is to evaluate the stage of disease and look for comorbidities to determine if they are at a high risk for disease progression in the absence of treatment.