Implementation of Indication-Based Hepatitis C Formulary Results in Greater Access to Care and Lower Drug Costs

SITUATION
A More Effective—But Expensive— Hepatitis C Treatment is Introduced
According to the Centers for Disease Control and Prevention (CDC), about 3.5 million Americans are currently living with the hepatitis C virus (HCV) and roughly half are unaware of their infection. HCV is a leading cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC), as well as the most common indication for liver transplantation in many countries. In the US, about 70% of individuals infected with HCV have genotype 1, 16% have genotype 2, 12% have genotype 3, and less than 1% have genotypes 4 through 7.

Once diagnosed, patients can take advantage of new, highly effective treatments, known as direct-acting antivirals (DAA), that cure the vast majority of infections within two to three months. This is in stark contrast to the standard HCV treatment prior to 2011 (a combination of interferon and ribavirin), which required 24 to 48 weeks of therapy and yielded significantly lower cure rates. While newer medications have transformed the treatment of HCV, they come with high price tags. Gilead’s Harvoni®, for example, costs approximately $94,500 per patient for 12 weeks of therapy, and the Viekira Pak™, manufactured by AbbieVie Inc., costs approximately $83,000 per patient for the same duration of treatment.

SOLUTION
Updated Formulary to Include Affordable Option
WellDyneRx is committed to offering our clients and plan participants the best clinical prescription benefit options at the lowest cost. As a reflection of that commitment, WellDyneRx was the first pharmacy benefit manager in the country to adopt a Hepatitis C indication-based formulary using Zepatier as our preferred product for patients with genotypes 1 and 4. When Merck & Co. Inc., the manufacture of Zepatier, set its list price at $54,600 for a 12 week regimen, our clinicians immediately recognized the significant cost-saving opportunities. This price is 34% lower than the Viekira Pak and 42% lower than Harvoni. Additionally, the clinical outcomes for patients using Zepatier were proven to be equivalent—or better—than higher cost medications in the same therapeutic class.

RESULTS
In the First 6 Months, 36% Increase In Hepatitis C Treatment Approvals
WellDyneRx clinicians reviewed pharmacy-paid claims data from the first six months of 2016 (1H16) and the first six months of 2017 (1H17) to identify patients who completed Hepatitis C therapy. They also looked at ultimate prior authorization determinations to pinpoint patients who requested coverage for treatment with one of the new DAA therapies. Zepatier was adopted by WellDyneRx as the preferred agent for patients with genotypes 1 and 4 in January 2017. When clinicians compared claims from 1H16 with 1H17, they found a substantial 36% increase in the percentage of patients approved for treatment following the implementation of the indication-based HCV formulary. Significantly, during this same time period (1H17), total drug costs decreased by 35%. This translates into huge savings for our clients in that, for every 100 HCV patients treated, total drug spend could be reduced by $3.35 million.

THE BOTTOM LINE
Average Patient Cost Savings of 35%—$33,551!
Implementing an indication-based HCV formulary with Zepatier as the preferred agent for treatment of genotypes 1 and 4 resulted in a significant 36% increase in the percentage of patients treated in 1H17 over 1H16. In addition, for each patient who completed treatment, the average cost decreased by 35%, or $33,551, in 1H17.

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