Hemophilia A Treatment Landscape: Insights and Role of Pharmacists


Experts explore the impact of hemophilia on patients’ lives, economic impact, and the crucial role of specialty pharmacists.

Jonathan Ogurchak, PharmD, CSP: Hello, and welcome to this Pharmacy Times® Practice Pearls, Examining the Treatment Landscape, Recent Clinical Data, and the Role of Specialty Pharmacists in Hemophilia A. My name is Jonathan Ogurchak, [PharmD, CSP]. I’m the cofounder and chief executive officer of Zeal Specialty Pharmacy in Pittsburgh, Pennsylvania. Joining me today in this discussion are Dr Atta Chowdhry, [RPh,] from Amerita in Greenwood Village, Colorado; Dr Lisa Schrade, [PharmD,] from Optum Infusion Pharmacy in Las Vegas, Nevada; and Dr Robert Sidonio Jr, [MD, MSc,] associate professor of pediatrics, director of clinical hemostasis and thrombosis research and operations from the Children’s Healthcare of Atlanta in Atlanta, Georgia. Today we’re going to talk about several topics, including the treatment landscape of hemophilia A, advancing practice patterns with recent clinical data in hemophilia A, and the role of specialty pharmacists in accessing newer medications for patients with hemophilia A. With that, let’s get started. I’d like to talk first a little bit about the treatment landscape and some of the algorithms that are utilized within hemophilia A. It’s often associated with both a patient and economic burden. Dr Chowdhry, could you talk a little bit about the impact of hemophilia, first for patients and their impact on quality of life, and then we could talk a little bit about the economics thereafter?

Atta Chowdhury, RPh: Definitely there is a significant impact on the quality of life if the disease state is not managed correctly. With hemophilia A, [some of] the quality-of-life measures [are] that [the disease] can cause some physical issues, emotional issues, economic cost. In the past, if you grew up with hemophilia in 1980s, you ended up getting HIV [human immunodeficiency virus]. If you made it through the 1980s and then you ended up in 1990s, you ended up with hemophilia with hepatitis C. [From] the insurance point of view, in those days and even up before the passage of the ACA [Affordable Care Act], there [has been] a million-dollar cap on most of the commercial insurances. [For] a patient who has congenital disease, hemophilia is not caused by a lifestyle choice. The patients who are little kids, their parents have to switch jobs because they hit that million-dollar cap in couple of years. They have to go find a different employer in order to get on a different health care plan or work for a bigger health care employer who has multiple plans available. From the physical point of view, hemophilia can cause some significant hemophilic arthropathy, but there is a target joint, [where there are] 3 or more bleeds in the same joint over the period of 6 months, which can cause significant long-term damage. From an economic point, [there is] a direct cost of the medication, hospitalization. Then there is an indirect cost of missing work, missing school, and having [those] difficult choices.

Jonathan Ogurchak, PharmD, CSP: You mentioned the economics a little bit for individuals. What about the US health care system as a whole?

Atta Chowdhury, RPh: [There is] a significant cost, especially if the hemophilia A patient develops an inhibitor, and 25% of the patients do develop inhibitors. That cost is significant because as soon as the factor is given to the patient it is consumed by the inhibitor, and then you have to give a large number of doses, and as we all know the cost of those drugs [is] not cheap or less, so that can cause a significant impact on the insurer and all these patients. I think that most of the insurers know those patients, even though there is a very small population. If you look at overall disease state, of course other disease states have a lot bigger impact economically, but the number of patients, if you go by [cost] specifically per patient, that’s a significant cost involved.

Transcript was AI generated and reviewed by a Pharmacy Times® editor.

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