Several states require that direct-acting antiviral medications for hepatitis C virus infection for Medicaid beneficiaries be prescribed by “specific provider types” — including infectious disease specialists, gastroenterologists, hepatologists and liver transplant specialists, according to CMS.
Infectious Disease News spoke with Stacey B. Trooskin, MD, PhD, director of viral hepatitis programs at Philadelphia Fight, about this specific Medicaid restriction, and whether specialized medication prescriptions from primary care providers should be covered by Medicaid.
If a provider is well-versed in the data and the literature and has experience treating HCV, it is in public health’s best interest to allow that provider to prescribe specialized medications.
This is particularly important in a resource-limited setting. For example, in rural environments there are often not enough specialists to provide subspecialty services and prescribe HCV medications to those in need. In those circumstances, it is critical that primary care physicians become trained in prescribing these medications, thereby making curative treatment accessible to patients living in rural environments.
There is definitely a need to expand treatment. We have seen the success of these models, particularly the ECHO model — Sanjeev Arora, MD, has published extensively on the success of PCPs providing HCV treatments in resource-limited settings with guidance and mentoring from subspecialty experts. This is an excellent way to train PCPs to become comfortable with using direct-acting agents.
- Arora S, et al. New Engl J Med. 2011;doi:10.1056/NEJMoa1009370.
Disclosure: Trooskin reports receiving grant funding from and serving in advisory positions for Gilead Sciences.
*Photo courtesy of Lorelei Narvaja