Health plans need strategies for managing high hepatitis C treatment costs, UMass Medical School expert says

April 11, 2018

Hepatitis C is curable, with a new class of drugs boasting success rates of 90 percent or more. Yet these medications are also extremely expensive, with treatment running into the tens of thousands of dollars for individual patients.

For state Medicaid programs and other health plans, that can pose some serious cost issues, notes Pavel Lavitas, PharmD, BCPS, of UMass Medical School. However, health plans can keep costs in line while optimizing outcomes.

“There are a number of strategies that health plans can utilize to control the costs of Hepatitis C medications,” says Lavitas, a clinical consultant pharmacist with Clinical Pharmacy Services and a frequent speaker on hepatitis C medication management. “All the strategies involve collaboration between the insurer, the patient, the pharmacy and the manufacturer.”

One key strategy is to select one or two drugs as “preferred.” In exchange, the manufacturer provides a rebate. “This strategy can be employed after a careful review of evidence-based medicine and up-front drug costs,” Lavitas says.

A second strategy involves using prior authorization to manage access to novel Hepatitis C medications.  The aim is “promote cost effective use of limited health care resources, but also to optimize member outcomes,” explains Lavitas.

Other strategies include:

  • Step therapy, which involves starting off with one medication and then stepping up to more expensive treatments if that doesn’t work;
  • Setting quantity limits to prevent overuse or stockpiling of a medicine by the patient;
  • Limiting the duration of the pre-authorization;
  • Phoning members with reminders and providing patient education;
  • Identifying members at risk of dropping their treatment regimen and enrolling them in a case management program.

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