April 01, 2019
Genotypic HIV resistance testing: adaptation of the EBM in Germany
In connection with the early benefit assessment of the Federal Joint Committee for the HIV drug Dovato, which combines the integrase strand transfer inhibitor dolutegravir, with the nucleoside reverse transcriptase inhibitor lamivudine, it was necessary to restructure the HIV resistance tests in the EBM (German Uniform Evaluation Standard).

As of April 1, 2020, fee order items (GOPs) 32821 and 32828 will map the required HIV resistance tests for the currently used antiretroviral agents for HIV therapy in EBM. The tariffs will stay unchanged amounting €260 for each of the listed GOPs.

Accordingly, the investigations will be restructured for the GOPs 32818, 32821, and 32822, and the active ingredient groups listed there will be combined in the GOP 32821. The GOPs 32818 and 32822 will be excluded from the EBM.

In the new version, the GOP 32821 will now cover genotypic HIV resistance testing in HIV-infected persons before specific antiretroviral therapy or if therapy failure is suspected with the following substance classes according to a summary of the characteristics of a drug (specialist information):
  • Integrase inhibitors or
  • Coreceptor antagonists or
  • Fusion inhibitors.
The GOP can be calculated for each substance class.

The GOP 32828 will cover genotypic HIV resistance testing in HIV-infected persons before specific antiretroviral therapy or if therapy failure is suspected with the following substance classes:
  • Protease inhibitors and/or
  • Reverse transcriptase inhibitors.
The full details in German can be found here. The corresponding decision of the Evaluation Committee can be found here.

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