Medi-Cal Will Reimburse Two HIV Drug Resistance Tests

Medi-Cal, California's Medicaid program, has approved reimbursement for two HIV drug resistance tests. Under the plan, Medi-Cal will reimburse ViroLogic Inc.'s PhenoSense HIV and GeneSeq HIV drug resistance tests for up to four tests per year per patient for the 27,000 HIV-positive Californians enrolled in Medi-Cal. In addition, Medi-Cal has certified ViroLogic as an "approved phenotypic and genotypic testing facility." Medi-Cal, the nation's largest Medicaid program, often "sets the standard for other public and private payers," according to a ViroLogic release, and could possibly influence other insurers to cover resistance tests (ViroLogic release, 3/28).

Genotypic Testing Cost-Effective
Testing HIV patients for viral resistance before they begin a new drug treatment program not only helps a physician select a more tailored course of therapy, but could also end up saving money in the long term, Reuters Health reports. According to a study published in this week's Annals of Internal Medicine, "expensive" genotypic tests, which range from $400 to $1,000, may be a "cost-effective" method of choosing drug treatment regimens (Reuters Health, 3/20). The study states that antiretroviral therapy "frequently" fails due to the development of different strains of the virus that have "reduced susceptibility to antiretroviral drugs." Genotypic tests, however, can detect these drug-resistant mutations and "predict virologic response." Overall, the study found that genotypic testing boosted patient life expectancy by three months (Weinstein et al., "Use of Genotypic Resistance Testing to Guide HIV Therapy: Clinical Impact and Cost-Effectiveness," Annals of Internal Medicine, 3/20). And while the cost of testing patients before they had failed a drug regimen was "heftier," the report found that the tests "may become more cost-effective as viral resistance grows more common." In addition, researchers found that the increase in patients' quality of life outweighed the initial costs of the tests, "presumably" because early testing would keep them healthier and out of the hospital for longer periods of time (Reuters Health, 3/20). Researchers wrote that the "incremental discounted cost" of phenotypic tests was $3,300 per patient, but saved $17,900 per quality-adjusted life-year. While the researchers state that the findings are "speculative," they add that genotypic testing "is cost-effective under a wide range of assumptions regarding effectiveness and cost" and is "appropriate for routine management of HIV disease" (Annals of Internal Medicine, 3/20). To read the study, go to http://www.annals.org/issues/v134n6/full/200103200-00008.html.