Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States, affecting at least 3.2 million people. There are medications available to treat — even cure — HCV to prevent serious complications, but the therapies come at a high cost and can vary in tolerability and duration. If a patient does not properly adhere to the medication, the treatment may be less effective and viral resistance can develop. This can result in additional medication expenses, disease progression, and continued risk of transmission of the infection to others.
We developed and implemented several management strategies for use in states, pharmacy benefit management programs, health plans, and other organizations, which help to promote optimal therapeutic outcomes and contain costs. Services include:
- Prior authorization review to ensure that the most clinically appropriate regimens are prescribed. Our HCV treatment guidelines are developed with input from infectious disease specialists and are consistently revised as consensus guidelines are updated and additional clinical data is published.
- Medication adherence tracking to ensure patients properly refill and complete the prescribed treatment regimen.
- Prescriber outreach and education to discuss optimal therapies based on member- and virus-specific characteristics, improve medication adherence, and gather outcomes regarding the effectiveness of treatment regimens.
- Outcomes analysis and reporting to assess and build upon strategies for medication use and adherence, collect outcomes on cure rates, and calculate cost-avoidance for patients who have completed treatment with an optimized regimen.
We implemented a successful HCV medication monitoring program for MassHealth. The program is comprised of comprehensive prior authorization criteria, prescriber outreach to propose optimized treatment regimens, and monitoring and intervention to maintain member medication adherence. In just over 13 months, the program resulted in cost avoidance of more than $3.7 million and a return on investment of $10 for every $1 spent on the program.