Powering Decision Support for Specialty Drugs: How Technology is Keeping Pace with Therapeutic Breakthroughs in Hepatitis C and Oncology

Specialty Pharmacy TimesMay/June 2016
Volume 7
Issue 3

Physicians are challenged with differentiating among a wide array of treatment options, with varying regimens and indications, and then monitoring patients according to the specific guidelines for each therapy.

IN THE PAST 2 YEARS ALONE, exciting innovations in the fields of gastroenterology and oncology have changed the way that many providers practice medicine on a daily basis. Take the case of hepatitis C virus (HCV), where the clinical challenges typically included too few drugs with too many side effects, leaving providers with limited treatment options.

Today, the challenge for physicians is differentiating among such a wide array of drug options with varying regimens and indications, and then monitoring patients according to the specific guidelines associated with each therapy. On top of that, physicians are increasingly burdened by dealing with the complex prior authorization requirements from payers looking to manage the costs associated with these innovative therapies.

Matching the Right HCV Therapy to Each Patient

The goal of therapy when treating a chronic HCV infection is sustained virologic response (SVR), which reflects HCV eradication. But the nuances of “how” to get there are not nearly as straightforward. Direct-acting antivirals feature short treatment duration and improved safety profiles.

These drugs are designed to achieve higher SVR rates for specific genotypes and based on other unique patient health characteristics. These agents include sofosbuvir (Sovaldi); simeprevir (Olysio); daclatasvir (Daklinza); the co-formulation of ledipasvir with sofosbuvir (Harvoni); a co-formulation of ombitasvir and paritaprevir with ritonavir (Technivie); ombitasvir, paritaprevir, and ritonavir tablets co-packaged with dasabuvir tablets (Viekira Pak); and the co-formulation of elbasvir and grazoprevir (Zepatier).

Providers attempting to select the right regimen for patients must take into account the efficacy, duration, and side-effect profile of each drug, as well as the patient’s HCV genotype, potential drug interactions, treatment history, comorbidities, and disease progression. Given that certain genotypes are more difficult to treat, this may narrow the field for providers.

However, there is still a wide variety of other nuances to today’s therapies that must be considered. For example, in the case of a drug like Zepatier, polymorphism tests may be administered to ensure that patients don’t possess certain genetic mutations that lead to treatment resistance. Patients infected with HIV, those with more advanced liver damage and cirrhosis, and those with kidney issues, present unique challenges all their own.

Providers Inundated with Clinical and Prescribing Information

Yet, with these new options has come an overwhelming amount of information that providers must sift through to find the most appropriate treatment options for each patient. As new drugs are introduced, and indications change rapidly, staying up-to-date with the latest clinical insights is a time-consuming endeavor.

At the same time, the current emphasis on evidence-based medicine has never been stronger, meaning that providers must have access to the right information at the right time to match patients with the most appropriate therapy. Finally, the cost of these new drugs must also be taken into account, as even insured patients face higher out-of-pocket costs than ever before.

Today’s direct-acting antivirals used to manage HCV can cost upward of $80,000. New oncology therapies are also expensive, and many have extended treatment regimens of a year or more. As a result, providers comparing drugs with similar efficacy and safety profiles often consider cost as a major factor in treatment decisions.

New Technology Provides an Avenue for Decision Support

Given all of this complexity, it makes sense that drug manufacturers and specialty pharmacies have a distinct opportunity to streamline provider decision making around specialty drugs. New technology is also providing the means for these organizations to do so.

Physicians are already utilizing digital channels for communication and knowledge at a rapid pace—from smart phone apps to social media. Increasingly, they are also turning to organizations like the National Comprehensive Cancer Network to explore the latest clinical guidelines and treatment protocols.

Yet, in the specialty drug arena, this information is often found in a wide variety of disparate places—meaning that providers must seek out medication information from many different sources, including resources from individual drug manufacturers.

Mobile Apps Put Prescribing and Other Specialty Drug Information in the Right Hands

A few new web- and mobile-based apps are attempting to address this challenge. For example, Avella Specialty Pharmacy has just released 2 unique provider apps that give physicians a fast, easy, and valuable way to match patients with the most effective, appropriate drug option from the latest breakthrough therapies.

Avella selected 2 initial focus areas for the apps, HCV and oncology, given the incredible growth of treatment options in these areas. Drugs from a wide variety of manufacturers are represented.

Seven direct-acting HCV therapies, including Zepatier, are featured in the Hepatitis Medication Guide app, and 50+ oral oncolytics for patients with various types of cancers are included in the Oncology Medication Guide app.

Providers receive immediate access to targeted prescribing information about these therapies all in one place. With the HCV app, physicians can also generate a recommended treatment regimen by entering detailed information about the patient’s unique health status and needs.

This includes a patient’s genotype, treatment history, liver health, biopsy results, transplant status, and other clinical factors. In response to all of this data, the app will recommend the most appropriate drug option, along with dosing, treatment length, expected SVR (based on a variety of factors such as patient status and health characteristics), and potential drug interactions.

This process is entirely intuitive, guiding the user through topics and areas such as state of cirrhosis, resistance patterns, and genetic markers. This is especially helpful in the case of drugs that are contraindicated in patients with certain health issues and resistance mutations.

Helping Patients Access Financial and Prior Authorization Support

Providers can also use apps like the ones developed by Avella to help comply with prior authorization requirements from payers, ensuring that a patient meets the clinical guidelines for a given therapy. Although health plans are tightening the approval processes on high-cost therapies overall, strict requirements exist for the patient characteristics, treatment history, and testing that must take place before approval.

For patients who cannot afford the cost of their medication with or without insurance, providers can also use these apps to locate financial assistance programs that may be available to patients based on need.

The Next Generation of Specialty-Specific Mobile Apps

Having all of this information from a variety of manufacturers in one place will streamline an incredibly complex and cumbersome prescribing process for physicians. As a result, specialty pharmacies like Avella are able to offer providers more than just access to the latest breakthrough therapies—they can actually empower physicians with the knowledge needed to select the most powerful and effective options.

Oncology and HCV are just 2 examples of areas where mobile health technology can ease the burden on specialty drug prescribers. Other mobile-enabled tools for fertility, HIV, and other specialties are likely to follow suit.

In the meantime, physicians treating HCV and oncology patients can access prescribing information and clinical insights in a completely new way, giving them more time to focus on managing treatment and improving patient outcomes. SPT

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