From Recognition to Prior Authorization: ATTR-CM Diagnosis Gaps

In an interview with Pharmacy Times, Janice Pieretti, MD, FACC, associate professor of clinical medicine at the University of Pennsylvania and medical lead for cardiac amyloidosis at the Hospital of the University of Pennsylvania, discussed why early diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) has become more urgent and what still stands in the way.

Pieretti noted that early diagnosis has always mattered, but it matters more now because available therapies can change the course of disease progression and significantly improve quality of life. Because current therapies do not reverse damage already done by amyloid deposition, she explained, their value lies in what she described as halting progression, preserving quality of life, and keeping patients from progressing to advanced heart failure symptoms.

Turning to barriers, Pieretti said recognition of ATTR-CM has improved dramatically over the last decade among general cardiologists and heart failure specialists, but awareness still needs to grow in primary care, orthopedic, and neurology settings, where patients can get lost seeing different specialists before their extracardiac manifestations are linked. She also pointed to difficulty completing and correctly interpreting the diagnostic evaluation in some community settings, limited timely access to amyloidosis centers for patients in rural areas, and the challenge of obtaining prior authorization outside of specialized amyloidosis centers.