An approach that has been seen by many providers has been to restrict access to medications using certain criteria. In the case of XAND (XMRV associated Neuro Immune Disease) such as Fibromyalgia, Chronic Fatigue Syndrome, the approach insurers may likely take would be to demonstrate a certain level of disability, and have failed other drugs beforehand. A primary care trust for example might require a certain disability score and fail to respond to a course of Lyrica and Ritalin. For insurers, the cost of treatment remains to be determined, and the following questions need to be addressed over time:
- Is the new drug more effective than the old one?
- What benefit does the drug have in terms of quality adjusted life years score?
- Will a lifelong course of medication be required as in HIV?
- Will other antivirals be required to treat co-infections, such as cytomegalovirus, EBV, HHV-6?