To help manage costs, the panel noted that managed care organizations could move coverage of the new orals into the pharmacy benefit
With the price of new medications for hepatitis C (HCV) estimated at $1,000 a day, it’s obvious why the category is a concern for payers. And more drug therapies are in the pipeline. Utilization management controls must be built for net value.
An edcuational panel discussion, “Keeping Pace With New HCV Treatment and Management Strategies,” moderated by Steve Casebeer, executive vice president, Impact Education LLC, a medical education company, covered the following:
Panelist Pamela Belperio, PharmD, noted that prior to the Affordable Care Act (ACA), only about 36% of those eligible for HCV treatment had health insurance.
To help manage costs, managed care organizations could move coverage of the new orals into the pharmacy benefit, allowing for more utilization data and avoiding potential price mark-ups by physicians. In many cases, payers are adding or have already added fourth tiers to their formularies to accommodate specialty drugs, whose member cost share is usually coinsurance.
While the drugs’ added value-fewer side effects, shorter duration of treatment and increased effectiveness in SVR-makes them attractive to patients and physicians, their cost can be difficult for payers to justify. Payers must create sophisticated policies for who should receive the drugs and when.
Not only have the new drugs’ costs shaken up treatment for HCV, but so has their promise of improved efficacy and safety. Sofosbuvir and simeprevir are oral, once-a–day medications that allow a shorter duration than their blockbusting predecessors, boceprevir and teleprevir, which entered the marketplace in 2011.
As a first line of therapy, experts recommend sofosbuvir daily with weight-based ribavirin, plus weekly pegylated interferon for 12 weeks to treat genotype 1. Daily simeprevir for 12 weeks with ribavirin, plus weekly pegylated interferon for 24 weeks, are seen as an alternative.
Panelist Fred Poordad, MD, said sofosbuvir is very well tolerated and provides high SVR even in cirrhosis. He also said simeprevir + sofosbuvir is a promising combination, which would translate to two pills once daily for 12 weeks. However, there are still questions and challenges, not the least of which is, “Who is paying for it?”
Panelist Stuart Gordan, MD, said leveraging expanded coverage under ACA is one of the key strategies to address lack of access to treatment for patients. Pharmaceutical manufacturer patient assistance programs that offer out-of-pocket discounts, collaborative care models and co-localized services can also help improve access.
Find clinical guidelines for HCV treatment here.