Overview of Comprehensive Hepatitis C Virus Medication Management in a State Medicaid Program

Wednesday, October 5, 2016
Cover of October Journal of Managed Care & Specialty Pharmacy
Pavel Lavitas, PharmD, BCPS
Commonwealth Medicine
Mark Tesell, PharmD, BCPS
University of Massachusetts Medical School
Tasmina Hydery, PharmD, MBA, CGP
University of Massachusetts Medical School
Bonnie Greenwood, PharmD, BCPS
Commonwealth Medicine
Mylissa Price, MPH, BS, RPh
Commononwealth Medicine
Kimberly Lenz, PharmD
Commonwealth Medicine
Paul L. Jeffrey, PharmD
Commonwealth Medicine

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.

The HCV medication management program and its success was highlighted in a research focus published by the Academy of Managed Care Pharmacy and featured in Pharmacy Times magazine.