Download Managing Hepatitis C Costs, Improving Patient Outcomes

Clinical Insights: feature
Hepatitis C
Managing Hepatitis C Costs, Improving
Patient Outcomes
Mary Dorholt, PharmD
With New Drugs and
the Support of Specialty
Pharmacists, Higher Cure
Rates Are Achievable for
Patients with HCV
T
hough 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 ther-apy
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 pharmacy, we work to ensure healthier outcomes
at lower costs.
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Table 1: Treatment Costs for Currently Available Hepatitis C Drugs
Drug
Supplied
Costs per Tablet/
Capsule*
Daily Cost
Treatment Duration Cost
Olysio
150 mg capsule
$948
$948
$79,632 (12 weeks)
Sovaldi
400 mg tablet
$1000
$1000
$84,000 (12 weeks)
*Based on average wholesale price.
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 virulogic 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.
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.
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
Table 2: Adherence Counseling for Patients with Hepatitis C
Patients
Initial
Ongoing
Follow-up
• Therapy and disease state
overview: administration,
side effects, importance of
compliance to achieve viral
response
• Storage, ancillary supplies
and delivery logistics
• Ongoing education/
intervention
• Depression screening
• Discuss diagnosis, treatment,
prescription, OTC profile
• Review dose, administration,
duration of therapy, storage
• Depression screening
• Counsel to manage barriers to
adherence and complex regimens
• Guidance for missed doses, side
effects
• Laboratory reminders and
importance of timely viral load
testing
• Adherence assessment,
drug-on-hand, timing of
refill/renewal
• Address barriers to compliance
• Adherence counseling as
needed
• Enact dispensing and/or
prescriber engagement to
support regimen adherence
Specialty Pharmacy Times® | 8.14 n 33
Clinical Insights: feature
Hepatitis C
About the Author
Table 4: Accredo’s Hepatitis C Medication Adherence App
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.
Medication Reminders
Reminders pop up when it’s time to take a medication; user can
mark as taken, snooze, or mark as skipped
Adherence Graph
Users can view a graph that charts their adherence through the
course of therapy
Viral Load Graph
Users can enter viral load following lab work, and app will graph
their viral load over time
E-mail
Medication regimen, adherence graph, and viral load graph can all
be e-mailed to doctor/nurse/caregiver for easy reference
Tracking
Users can create several types of entries, including viral load,
doctor visit, symptoms, and journals to track their progress
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.
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 patientspecific 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 overor underdosing, and identify potential risk
factors or gaps in care.
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
Table 3: Pharmacist Contact with Physician During Hepatitis C Therapy
MD
Initial
Follow-Up
• Verify diagnosis, dose, viral genotype,
comorbidities
• Regimen conformity with treatment
guidelines
• Patient or caregiver administration, ancillaries
• Support and toll-free number
• At each futility point, end of therapy, and ad hoc
• Barriers to compliance
• Adverse effects, administration, cost, complex
therapy
• Viral load evaluation, response to therapy, duration of therapy
34 n 8.14 | Specialty Pharmacy Times®
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 availble 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
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