Managing Hepatitis C Costs, Improving Patient Outcomes

Specialty Pharmacy Times, July/August 2014, Volume 5, Issue 4

New drugs to treat hepatitis C herald a new era of higher cure rates, but with these new treatment options comes an increased need for patient support and adherence counseling.

New drugs to treat hepatitis C herald a new era of higher cure rates, but with these new treatment options comes an increased need for patient support and adherence counseling.

Though hepatitis C has long been considered a condition where the treatment was often worse than the disease, hepatitis C medication regimens are undergoing a huge evolution.

Evolving Treatment Landscape

New polymerase inhibitors on the market have already shortened the length of treatment regimens from nearly a year to about 12 weeks. Cure rates have increased from less than 50% to nearly 90%. And new therapies have cut dosing frequency from several times a day to just one. Additional drugs in the pipeline will further simplify treatment and are expected to improve cure rates to more than 90% while potentially shortening therapy length to as few as 8 weeks.

Start at Specialty

However, major challenges remain, including nonadherence and risk of therapy failure for patients and soaring costs for payers. Accredo offers specialized patient counseling and support and cost-control strategies for plan sponsors.

When patients with hepatitis C virus (HCV) start at Accredo specialty pharm-acy, we work to ensure healthier outcomes at lower costs.

New Drugs Mean Higher Price Tags

While the new HCV drugs on the market improve cure rates and simplify treatment, they also come at a high price tag—up to $1000 per pill.

Additional therapies in the pipeline will doubtless carry similarly high, if not higher, costs.

Specialized Support, Higher Adherence

A major challenge with HCV treatment is nonadherence. In order to achieve a sustained virologic response—which indicates the patient is cured—strict adherence to the therapy regimen is a must. With older drugs, the regimens were long, often up to 52 weeks, and often carried risk of serious side effects, including fatigue, flu-like symptoms, and even suicidal tendencies. This increased the chances of a patient becoming nonadherent and therefore failing therapy.

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Research from the Express Scripts Drug Trend Report shows that historically, 40% of all HCV patients were nonadherent to therapy across dispensing channels.

Recently approved HCV medications have shorter regimens, higher cure rates, and milder side effects. However, with those, as well as the next generation of HCV treatment in the pipeline, adherence continues to be a challenge and nonadherence could mean the risk of therapy failure.

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Express Scripts research published in the American Journal of Pharmacy Benefits shows that patients using a specialty pharmacy had 15 fewer therapy gap days and an 8.6% higher adherence rate than those using a retail pharmacy. In fact, the study demonstrated that patients who exclusively used a specialty pharmacy had a 60% greater likelihood of achieving optimum adherence compared with retail pharmacy users.

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Specialty-trained pharmacists and nurses in the Express Scripts Therapeutic Resource Center, offered through Accredo, have disease-specific expertise in HCV. These pharmacists receive additional education in managing HCV and spend a majority of their time providing clinical counseling to patients. They can assess every case to ensure that the patients receive the right drug regimen in right dosage at the right time. They can also provide patient-specific counseling and proactively work with physicians at the beginning of therapy and throughout treatment to help patients achieve optimal adherence, manage side effects and adverse events, and ensure healthier outcomes.

Collaborating with Physicians

Accredo’s specialist pharmacists and nurses can work directly with the physician to help prevent therapy duplication and over- or underdosing, and identify potential risk factors or gaps in care.

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Benefit to Plan Sponsors

Specialist pharmacists can also help payers save money. For instance, combination therapy with Olysio costs more than $135,000 for 48 weeks. Treatment-naïve patients should receive only 24 weeks, as opposed to patients who have failed therapy in the past, who receive 48 weeks. When a patient is first diagnosed and prescribed HCV treatment, a pharmacist reviews the regimen and checks for prior treatment history and confirms the patient’s HCV genotype. In cases of inappropriate dosing, the pharmacist then reaches out to the physician with a recommended therapy change. A change in the prescription from 48 to 24 weeks of therapy can save the client $23,000.

Accredo also has other utilization management programs in place to help payers manage utilization while ensuring healthier outcomes for patients.

Leveraging Technology

According to the National Council on Patient Information and Education, more than 60% of patients cannot recall their physician’s instructions regarding medication 10 minutes after they leave the doctor’s office. To help patients stay on track and avail themselves of important treatment information whenever and wherever they need, Accredo offers an online HCV virtual coaching video as well as a support community through the HepatitisNeighborhood.com website.

The Accredo Plus C app, now available in the Apple app store, includes easy-to-use therapy calendars, resource libraries and dose reminders (see Table 4).

As HCV treatments evolve, patients have a better chance than ever of a cure. Accredo specialty pharmacy can help ensure they complete therapy successfully, while saving plan sponsors money. SPT

About the Author

Mary Dorholt, PharmD, leads Express Scripts’ specialty clinical strategy and protocol development. In this role, Mary and her team of clinical experts develop clinical guidelines for patient care and physician interaction for this complex and growing area of the pharmacy and medical benefit. She is also responsible for driving organizational research on specialty medications and the Express Scripts experience.Dr. Dorholt has a 17-year history at Express Scripts and the former Medco organization. Prior to her current role, Dr. Dorholt was responsible for provision of specialty strategic guidance to employer, government, and labor organizations. In this capacity she was also responsible for marketplace oversight and internal and external communications related to specialty drug management.Dr. Dorholt has extensive knowledge and experience in the development and implementation of specialty solutions, Medicare Part D strategies, and clinical support services. She has been a frequent speaker on specialty and Medicare topics during her tenure. Dr. Dorholt received her Doctor of Pharmacy degree from the University of Minnesota College of Pharmacy in Minneapolis. She holds bachelor’s degrees in mathematics and biology.