Understanding and Exploring the Practice of Specialty Pharmacy - Episode 15

Episode 15: Are High Cost Hepatitis C Medications Worth the Price Tag?

Ray Tancredi, RPh, MBA, CSP, vice president of specialty pharmacy development at Walgreens; Cheryl Allen, BS Pharm, MBA, vice president of business development and industry relations for Diplomat Pharmacy; Nicholas Karalis, RPh, of Elwyn Pharmacy Group; Stacey Ness, PharmD, RPh, CSP, MSCS, AAHIVP, director of specialty clinical services for Managed Healthcare Associates*; and Renee Rayburg, RPh, senior director of clinical consulting at Artemetrx, discuss the unique cost-effectiveness conundrum caused by new hepatitis C medications.

The recent breakthroughs in hepatitis C treatment come with cure rates of 90% and up with a hefty price tag: $1,000 a day or $84,000 for an average 12-week treatment duration. Ness pointed out that high cost drugs are usually for orphan disease states with very few patients, but the CDC estimates that approximately 3.2 million Americans have hepatitis C, creating a unique cost-effectiveness case study for the disease. To complicate matters further, Tancredi said that hepatitis C progresses slowly, and while 60% to 70% of patients will eventually have liver damage, only 5% to 20% of patients will progress to cirrhosis.

Because of the cost and nature of the disease, appropriate use is very important with these higher cost agents, Karalis said. Manufacturers are helping to offset high copays for patients who participate in commercial medical insurance plans, Allen added, but patients within government payor systems face financial barriers to coverage, and specialty pharmacies are helping by leveraging funding organizations.

There are now even newer combination therapies available that raise additional questions. The once-daily oral combination agent on the market ranges from 8 weeks to 24 weeks in treatment duration, which may lead to cost savings for some patients, but not for all of them, according to Rayburg. On the other hand, patients who require the longer duration for this drug, as well as for another new combination regimen, may incur costs that make $84,000 look like a deal.

*The views expressed are those of the individual alone and not of Managed Health Care Associates, Inc.