A review of the records reveals the member to be an adult female with a birth date of 02/13/1959. The member has a diagnosis of Chronic Hepatitis C, genotype 1 B compensated Liver Disease. The member’s treating provider, Brett Neustater, MD recommended the member be treated with Harvoni 90/400 mg tablets one po qd X 12 weeks.
The carrier has denied coverage of Harvoni 90/400 mg tablets one po qd X 12 weeks as not medically necessary. There is a letter from the carrier to the member dated 01/18/2016, which states in part:
“The specific reason for this denial of your appeal for Harvoni is that coverage guidelines have not been met based on AvMed’s Medical Department Procedure 07.171, ‘sofosbuvir /Ledipasvir (Harvoni®)’ and the manufacturer's
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In a long-term follow-up study, 820 patients with Metavir stage F0 or F1 fibrosis confirmed by biopsy were followed for up to 20 years. The 15-year survival rate was statistically significantly better for those who experienced an SVR than for those whose treatment had failed or for those who remained untreated (93%, 82%, and 88%, respectively; P =.003). The study argues for consideration of earlier initiation of treatment (Jezequel, 2015). Several other modeling studies suggest a greater mortality benefit if treatment is initiated at stages prior to F3. (Øvrehus, 2015); (Zahnd, 2015); (McCombs, …show more content…
(Foster, 1998) The presence and severity of fatigue appears to correlate poorly with disease activity, although it may be more common and severe in HCV-infected individuals with cirrhosis. (Poynard, 2002a) Despite difficulties in separating fatigue symptoms associated with hepatitis C from those associated with other concurrent conditions (eg, anemia, depression), numerous studies have reported a reduction in fatigue after cure of HCV. (Bonkovsky, 2007) In the Virahep-C study, 401 HCV patients were evaluated for fatigue prior to treatment and after therapy using validated scales assessing presence and severity of fatigue. (Sarkar, 2012) At baseline, 52% of patients reported having fatigue, which was more frequent and severe in patients with cirrhosis than in those without cirrhosis. Achieving an SVR was associated with a substantial decrease in frequency and severity of fatigue. A recent analysis of 413 patients who achieved an SVR12 from the NEUTRINO and FUSION trials treated with a sofosbuvir-containing regimen demonstrated improvement in patient fatigue (present in 12%) from the pretreatment level. (Younossi, 2014) After achieving an SVR12, participants had marked improvement in fatigue over their pretreatment scores using 3 separate validated
After serving 5 years in prison and 40 days in maximum security over the crime, Hawi appealed to the Court of Criminal Appeal on 18 July 2013. Hawi appealed for four main reasons - insufficient evidence of Hawi’s involvement in the murder of Anthony Zervas, unreasonable verdict in charging Hawi for the main perpetrator’s case, miscarriage of justice and disregarding ‘provocation’ to the jury. The NSW Court of Criminal Appeal set
HPI: MR is a 70 y.o. male patient who presents to ER with constant, dull and RUQ abdominal pain onset yesterday that irradiate to the back of right shoulder. Client also c/o nauseas, vomiting and black stool x2 this morning. He reports that currently resides in an ALF; they called the ambulance after his second episodes of black stool. Pt reports he drank Pepto-Bismol yesterday evening without relief. Pt states that he never experienced similar symptoms in the past. Denies any CP, emesis, hematochezia or any other associated symptoms at this time. Client was found with past history gallbladder problems years ago.
Three examples on why a claim may be denied are: 1. No preauthorization for non-covered benefits, 2. Processing errors on physicians end and/or no sufficient supporting documentation on why a certain procedure was done for a certain diagnosis, and 3. Incorrect CPT or ICD-9 codes. An EOB can prove a certain service or procedure was denied for the reason specified will be included in the “remarks or description field” in the
The Board received a complaint on 04/02/2014 regarding patient Gloria Kinder from Dena Andrews who has a POA for health care matters on the patient. The complaint was regarding Dr. Negron taking over care of the patient after her primary care doctor retired. The complainant states that the doctor would not refill her potassium, did not do follow up labs, and would not care for the patient.
Kanwal, F., Hoang, T., Kramer, J. R., Asch, S. M., Goetz, M. B., Zeringue, A., Richardson, P., & El-Serag, H. B. (2011). Increasing prevalence of HCC and cirrhosis in patients with chronic hepatitis C virus infection. Gastroenterology, 140(4), 1182-1188. doi: 10.1053/j.gastro.2010.12.032.
Although Pfizer was not required to warn the public and Kline, they were responsible for warning physicians. Pfizer dismissed Kline’s Complaints pursuant to Federal Rule of Civil Procedure 12(b)(6), which successfully dismissed Counts I and VII. Motion to Dismiss under Federal Rule of Civil Procedure 12(b)(6) “for failure to state a claim for which relief can be granted.” As the Plaintiff, Kline should have provided several sets of proof in order to support his claim and be granted the relief. Kline failed to provide the Fact Sheet and Authorization forms under the Joint Coordinate Plan.
The carrier’s decision in denying coverage for the ROM Plus testing [CPT code 84112] that was performed on 03/04/2015 as experimental/investigational was appropriate.
As chronic viral hepatitis has a high prevalence in patients with HIV, clinicians should assess the risk of development of hepatotoxicity in these patients whenever HAART is initiated.7
Hepatitis is inflammation of the liver. There are currently five known viruses that cause can hepatitis (Microbiology, 10e). The hepatitis C virus (HCV) is transmitted through contact with the blood of an infected person; however, it is now more commonly spread among IV drug users that share needles. Healthcare workers are also at risk for contracting HCV, but with standard precautions, the risk is low. “Prior to 1992, some people acquired the HCV infection from transfusions of blood or blood products. Since 1992, all blood products have been screened for HCV, and cases of HCV due to blood transfusion now are extremely rare. HCV can be passed from mother to unborn child. Approximately 4 out of every 100 infants born to HCV-positive mothers become infected with the virus. A small number of cases are transmitted through sexual intercourse; however, the risk of transmission of HCV from an infected individual to a non-infected spouse or sexual partner without the use of condoms over a lifetime has been estimated to be between 1% and 4%. There have also been some outbreaks of HCV when instruments exposed to blood have been re-used without appropriate disinfection.” (Microbiology, 10e)
Hepatitis C is a global burden that gives rise to serious liver complications. Thus, it is very crucial to eradicate this disease. Since there is no vaccine, drugs combinations become important elements in treating hepatitis C globally. Hepatitis C virus (HCV) is previously dealt with using combinations of drugs such as pegylated interferon (PEG-IFN) and ribavirin (RVB). These drugs are dependent on several factors such as HCV genotype, treatment duration, past treatment, side effects and the patient condition. In 2013, a promising antiviral drug, sofosbuvir, brings hope to the eradication of all genotypes of HCV. This bibliography would evaluate the effectiveness and safety of sofosbuvir in treating chronic hepatitis C either in combination with other drugs or alone. In addition to that, this bibliography and the following literature review will highlight the impact of sofosbuvir in the global eradication of hepatitis C. Add citation
There are a number of ways that the current treatment for hepatitis C could improved. In the future researchers aim to develop a more effective, safe and well-tolerated interferon therapy. They have also created a new vaccine technology that has been tested in mice for its therapeutic efficiency against the most conserved regions of the hepatitis genome. They hope to eventually develop drugs that target the hepatitis C RNA-dependant RNA polymerase enzyme, which is responsible for the replication of the entire hepatitis C genome, and prevent the replication of the hepatitis C virus directly.9 Although hepatitis C is a very serious disease of the liver, technologies and medications have been proven to be effective in many chronically infected persons with hepatitis C virus.
However, there are certain issues that may result from unfilled gaps between the expected and the actual provided health care treatment, and these issues vary in severity. But unfortunately, there are many people as patients who may not be fully aware of their legal right to file clinical negligence claims that could have been valid and successful.
Blackwell, Wiley. "Alcoholic Cirrhosis Patients Had High Prevalence of Complications at Diagnosis." ScienceDaily. ScienceDaily LLC, Apr. 27,2010. Web. 4 Nov 2011. .
There is a disease spreading out in the world called Hepatitis C. It affects the liver and may cause the liver to fail. This disease is caused by a virus called Hepatitis C virus which is also known as HCV. About 32,000 people are affected with this disease per year only in the United States area. Some It’s a disease with many symptoms and many causes. of these symptoms are easy bruising, upset stomach and fever. These are just some of the many symptoms that come from the virus. Hepatitis Cs nature of the causative agent is determined by many things. The biological data of this disease is filled so much information. It is estimated that over 180 million people have gotten Hepatitis C and it is growing.
One must evaluate all parties involved. It can be argued that do to the lack of documentation or communication of the physician this was an act of negligence. A jury can decide that lack of documentation is sufficient evidence in finding a physician guilty of negligence (Pozgar, 2009). When we look at the role of the defendant which was the pharmacist not the physician his duty goes above just filling prescriptions, the duty of a pharmacist is to monitor the patient’s medication. In order for him to have achieved this properly he should have made sure he contacted the physician for further information even if the physician failed to communicate with him. Because of his actions the plaintiff is holding the pharmacist accountable for his treatment and that is not where all of the blame should be consumed. The argument that can be made for the pharmacist is that the pharmacist acted within his scope of practice and left everything to the physician. This situation can easily be construed as, if the physician needed further medications or if there were any adverse reaction then he would have contacted the pharmacist. Once again the prosecutor may argue that the pharmacist had a duty to follow up on any treatment that he provided to a patient. These arguments would be the most persuasive. These are the key elements in determining the case being argued. For example the pharmacist not following up with the patient’s physician may be