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Survey: Most Specialists Don’t Support PCPs Treating Hepatitis C Patients

MCO pharmacy directors have different opinion (Nov. 19)

Decision Resources, a research and advisory firm based in Burlington, Mass., reports that, in contrast to surveyed managed care organization (MCO) pharmacy directors’ notable support for primary care physicians (PCPs) treating patients with hepatitis C virus (HCV) infection, most surveyed specialists are wary of PCPs treating this patient population. Less than one-third of the specialists were supportive of PCPs prescribing currently available HCV drugs, and slightly less than half supported the idea of PCPs prescribing oral interferon (IFN)-free regimens.

Thirty-five percent of specialists maintained that HCV patients should not be treated by PCPs, but instead should be treated by specialists in all cases. In addition, 45% of surveyed specialists thought the “ideal” HCV patient for treatment by a PCP would be one who is newly diagnosed or treatment-naïve with minimal or no fibrosis or other complications, thus requiring straightforward treatment with less monitoring, versus treatment that is required for sicker patients.

Similar to specialists’ perceptions of PCPs, the majority of surveyed PCPs reported that they are not familiar with current HCV therapies and are unwilling to prescribe or are uncertain about prescribing IFN-free therapies. Nearly three-quarters of surveyed PCPs said they would be uncomfortable with treating any but the most straightforward cases of HCV infection, such as treatment-naïve patients with minimal or no fibrosis — most likely because the majority of PCPs are unfamiliar with most currently available HCV antivirals. Moreover, many surveyed PCPs believed that their lack of training in managing HCV patients would preclude their use of IFN-free antivirals, even if these agents are safer and easier to use.

The survey also found that MCO pharmacy directors are supportive of PCPs prescribing not only currently available HCV therapies but also emerging IFN-free therapies to the most straightforward HCV patients (i.e., treatment-naïve patients with minimal or no fibrosis). Their support lessened as disease severity increased.

“Assuming oral, IFN-free therapy is available, at least 80% of surveyed pharmacy directors are supportive or very supportive of PCPs prescribing such therapy to treatment-naïve patients with moderate, minimal, or no fibrosis,” said analyst Seamus Levine-Wilkinson, PhD. “Overall, surveyed pharmacy directors are less supportive of such treatment by PCPs for nonresponders or for patients with severe fibrosis.”

Source: Decision Resources; November 19, 2012.

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