Experts Talk Trends in Hepatitis C Care

Panel discusses treatment barriers during annual NASP conference.

Panel discusses treatment barriers during annual NASP conference.

The topic of hepatitis C virus (HCV) was widely discussed at the recently held 2015 National Association of Specialty Pharmacy (NASP) Annual Meeting and Expo in Washington, DC.

Experts on the subject, Jason Lynn, PharmD, vice president of Clinical/Quality/Trade Services at ReCept Pharmacy and Imitiaz Alam, MD, clinical assistant professor of Medicine at the University of Texas Southwestern and medical director at the Austin Hepatitis Center, talked at length about trends in hepatitis C care.

In a presentation given by Lynn, one thing was abundantly clear: the cost of HCV treatment is a serious issue that is preventing much-needed treatment from taking place. With some medications costing nearly $50,000 per month, patients can hardly afford the care they need.

Additionally, private insurers have placed restrictions on treatment, indicating that patients will need to have chronic fibrosis before high cost therapy is approved.

“It’s getting tougher again to get patients treated,” Lynn said. “I think there’s a lot of barriers to care that we’re going to really see.”

One such barrier that hinges on affordability is adherence to care. If patients cannot afford their medications, there will likely be disruptions in their regimen, resulting in incomplete treatment.

This may prolong the length of time patients are set to be on their regimen, thus adding more cost to the patient.

“This may not be cost effective if we don’t cure them,” Lynn said.

Part of a physician’s job is to counsel patients on the importance of adhering to the specified regimen. If a patient does not adhere to their regimen, it may result in treatment failure.

“If you miss a couple of doses that is really not a good thing and there’s evidence to support that,” Lynn stressed.

Alam observed another trend in HCV care, which is a lack of screenings performed on the part of physicians.

“The problem is we’re not screening enough people and we’re not linking them to care,” he said.

New York was the first state to mandate screening for HCV in the United States. They screened approximately 5000 people and 380 came back RNA positive. Of those 380, only 16 pursued treatment.

“Linkage to care is the problem, it’s not the medication,” Alam said.

The medication is actually quite easy to tolerate and administer, with some regimens requiring as little as one pill per day.

“We would probably want primary care physicians to treat these patients as treatments get easier to administer,” Alam said. “Not every community has a specialist. Specialty pharmacy is going to be important in playing a role in educating primary care physicians to test more people and then provide access to information about who to go and see.”

In Alam’s opinion, the biggest issue with hepatitis C is the lack of information that it is curable.

“You can’t cure HIV, you can’t cure hepatitis B, but hepatitis C is curable,” he said.

This is a message that needs to be heard, as many patients with the chronic conditions are reluctant to get treatment due to the safety profile of older regimens with interferon and ribavirin.

As a closing message to patients with the chronic condition, Alam advises those with HCV to “choose wisely who treats you and choose wisely which drug you take” as many times with private insurers, patients only get one chance to get it right.

As hepatitis C care evolves and more drugs enter the marketplace, the hope is that costs will come down and related issues will resolve themselves.

Until then, patient adherence, rate of screenings, and education remain topics of importance to hepatitis C care trends analysts.