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Clin Med > HCV Quiz > Flashcards

HCV Quiz Flashcards

1
Q

who determines WAC price?

A

pharma company

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2
Q

what is exclusivity in terms of hep med pricing?

A

restriction on what meds can be prescribed

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3
Q

how pharma company “sells” exclusivity

A

vouchers/WAC discounts

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4
Q

the liason between insurance company and pharma company

A

PBM (pharmacy benefit manager)

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5
Q

who determines formulary placement?

A

insurance company (can be diff for medicaid, private)

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6
Q

who determines OOP cost and med choice for pt?

A

insurance

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7
Q

in certain states, infected ppl might not be able to get tx dependent about

A

liver fibrosis stage

drug use

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8
Q

VA system usually gets discount/increased WAC price

A

discount

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9
Q

prison usually gets discount/increased WAC price

A

increased

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10
Q

specialty pharmacies might get paid for

A

early d/c rate

SVR rate

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11
Q

Pt assistance programs might be offered by

A

pharma companies, foundations

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12
Q

focus of cea is

A

health benfits

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13
Q

icer

A

incremental cost-effectiveness ratio

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14
Q

ICER threshold aka “societal willingness to pay”

A

avg return in QALY expcted if available budget used for current healthcare system as opposed to the new tx

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15
Q

typical length time horizon

A

1-5 y

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16
Q

why difficult to judge cost effectiveness of HCV drugs

A

lack of transparency in negotiations

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17
Q

t/f when making coverage decisions, insurance considers OOP for pt

A

false - only their own revenues and bottom lines

18
Q

rivavirin - mechanism and SE

A

guanosine analog - inhibits viral RNA-dependent polymerase

SE: hemolytic anemia

19
Q

pegylated interferon - mechanism and SE

A

1) binds to membrane receptpr - inhibits viral penetration, translation… release
2) ^HCA, phaocytic activity of macophage, killer T survival

SE: flu like sx

20
Q

simprevir - mechanism and SE

A

NS3 - protease/helicase inhibitor
*use w/ or w/o riavirin

SE: rash, photosensitive, CYP interaction

21
Q

sofobuvir - mechanism and SE

A

NS5B - RNA pol inhibitor
works against all genotypes

CI: renal dysfunction

22
Q

ledapasvir - mechanism and SE

A

NS5A inhibitor - RNA replication assembly block

23
Q

standard first line HCV tx

A

sofosbuvir (NS5B RNA pol i) + ledpipasivir/RBV/Peg

24
Q

tx for kids >12yo and 77lb+

A

sofobusivir + ledapasvir

25
Q

which is only used in combo with sofobuvir (NS5B)

A

ledipsavir (NS5A)

26
Q

what covers all genotypes and can be used w/ NS5B/A

A

epculsa

27
Q

what covers all genotypes and can be used w/ NS5A or NS3/4A

A

mavret

28
Q

initial HCV testing and confirmation

A

HCV antibody

HCV-RNA sensitive test to confirm

29
Q

negative HCV antibody testing, but suspect illness. next step

A

if exposure w/in last 6 mo, HCV-RNA sensitive test. also if immunocompromised

30
Q

you cleared the virus, what test for monitoring if you are at risk for reinfection

A

HCV-RNA sensitive (the antibody will always be positive)

31
Q

test to confirm initial viral load before starting therapy

A

RNA-quantitative

32
Q

test to determine type of tx

A

genotype testing

33
Q

positive HCV antibody, negative RNA test - how to proceed

A

tell pt they don’t have active HCV

34
Q

other dz pt should be screened for after they get a Hep C dx

A

HIV and HBV

35
Q

vaccine to get after HCV dx

A

HAV and HBV

36
Q

vax to get after HCV + cirrohsis

A

pnuemococcal

37
Q

liver biopsy and imaging needed for what type of pt with HCV

A

all to determine HCC risk

38
Q

HCV treatment can cure what percent of pts

A

> 90%

39
Q

how was the Medicaid classified as permissible or restrictive

A

length of time needed to abstain from alcohol and drugs

40
Q

reported hcv incidence

A

0.8 per 100,000 persons

41
Q

why is hcv underreported?

A

most cases asymptomatic ; reporting requirements vary by state

42
Q

3 states w high incidence and comphrensive laws

A

ma, wa, nm

Clin Med (12 decks)

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