Payers have unmet needs in the changing hepatitis C (HCV) space, according to a recent survey. The survey, from Precision for Value, highlights what can be done to encourage payers to ease coverage policies for these drugs in the next wave of HCV treatment.
“Payer priorities are shifting to wanting agents that address difficult to treat HCV patients including those with less common genotypes and patients failing prior therapy,” says Jeremy Schafer, PharmD, MBA, senior vice president, director specialty solutions at Precision for Value.
The unmet needs cited by payers in the survey included addressing prior treatment failures (64%), overcoming resistance (52%), shortening the duration of therapy (40%).
Real-world outcomes a must
The survey found that 48% of payers wanted to see a real-world outcomes study. “Payers spend significant money on HCV treatments but may lack the other side of the story—what are they getting? Are patients staying adherent? Are they being cured? If so, does the cure rate match what was seen in clinical trials?” says Schafer. “Answering these questions for payers may make them more comfortable with broader coverage.”
Payers could partner with health systems or even specialty pharmacies to obtain information on cure rates or need for retreatment, Schafer advises. Manufacturers could also play a role by conducting real-world outcome studies to track the cure rates of patients treated on their product(s).
Even as utilization has plateaued or dropped, payers are guarded because HCV continues to be a cost driver, Schafer adds. “Aggressive contracting with an outcomes component where appropriate may ease access as well. Now that the category has matured, more payers want to see pharma back up their claims with outcomes data and even outcomes-based contracts.”
The survey results show that payers are satisfied with the clinical outcomes of the current leading agents. “The concerns around taking multiple agents with poor tolerability were removed by the newest therapies,” Schafer says. “Now that payers have single agents that can cure disease in a short duration, they are looking for pharma to fill gaps not addressed by current agents. Additionally, payers are even more focused on cost as the cure rates between therapies are so similar.”
Eighty-four percent of payers survey respondents were interested in an outcomes or risk-based agreement. However, Schafer says outcomes contracts are tricky and require two important components:
1. A defined outcome
2. The ability to track the outcome
“Payers seeking to execute an outcomes-based agreement should first review their own capabilities to determine what is reasonable but also look for partnerships, including with a specialty pharmacy, to see if these partnerships expand the payer’s options for an outcomes based agreement,” Schafer says.
Tracey Walker is content manager for Managed Healthcare Executive.