The new crop of hepatitis C drugs released over the past few years are both highly effective and highly expensive, says Pavel Lavitas, PharmD, BCPS, of the UMass Medical School. Given this financial reality, candidates for treatment must be chosen carefully.
The newest hepatitis C treatments now have double the cure rate – 90 percent or more – with a 12-week regimen instead of a year, according to the U.S. Food and Drug Administration. The medication also has fewer side effects and a higher tolerance among patients.
But the costs have also risen, Lavitas says.
Medicaid spent $7 billion on just one hepatitis C drug, at a cost of $93,000 per patient, when it was introduced in 2014. In some cases, a course of treatment for some medications can cost as much as $300,000, notes Lavitas, a clinical consulting pharmacist at the medical school who is a frequent presenter on hepatitis C medication management.
“Given the high cost of hepatitis C medications… as well as the high prevalence of the condition, it’s necessary to screen for appropriate candidates for hepatitis C therapy to ensure that health care dollars are well spent,” Lavitas says.
Problems with substance abuse issues or trouble in the past sticking with medication regimens can be red flags that a health plan member is in need of extra support and monitoring.
For health plans, identifying members who have struggled with medication regiments in the past can be crucial. Armed with this information, health plans will they will need to budget for medication management strategies aimed at helping these individuals stick with their treatments.
“It is necessary to identify the right candidates for treatment, work closely with prescribers on selecting optimized treatment regimens, promote medication adherence and collect treatment outcomes,” Lavitas says. “All these factors are important components of any medication management program.”