Currently, for many payors, the prescriber must either be an ID physician, hepatologist or GI specialist. The following work-up before referral for Harvoni or related HCV treatment:
1. HCVSAB, HCV viral load, Genotype, FIB4 score or some other assessment of fibrosis (elastography, liver bx)
2. If cirrhotic, what Child’s Class and any H/O decompensation (talk to me about criteria if you need)
3. Patient will require NS5A resistance testing if they have failed previous NS5A agents.
4. HAVtotal ab, HBVSAB, HBVSAG, Start immunizations if nonimmune.
5. HIV testing
6. CBC, CMP, INR (if indicated), HCC screening (if indicated), ANA, iron profile. Also, assessment for other causes of liver disease if clinically indicated.
7. Ultrasound liver
8. Urine drug screen and BAL when close to submitting PA.
9. Assessment of ability to adhere 100% to medications.
10. Urine HCG for any women who may require ribavirin.
11. Please run drug-drug interactions either using Lexicomp or Liverpool Hepatitis Drug interaction program (http://www.hep-druginteractions.org/)