Breakthrough direct-acting antivirals set a new standard in the management of hepatitis C virus (HCV) with regard to cure rates and improved tolerability; however, the health care system is challenged by the cost of these medications. A comprehensive HCV medication management program can help contain costs while ensuring that members have access to the most clinically appropriate regimens.
We designed a comprehensive HCV medication management program with prescriber outreach for a state Medicaid program that promotes optimized regimen selection and offers refill outreach to support medication adherence. As a result of outreach to more than 200 members, 19.6% had a subsequent prior authorization modification. The total projected cost avoidance was $3,770,097. The comprehensive HCV medication management program demonstrated an ROI of $10.28 for every $1 spent.