Case Study

Hepatitis C

Situation

Hepatitis C virus (HCV) is the most common chronic blood borne infection in the United States, affecting at least 3.2 million people. Many people who are infected are unaware they have the disease until they experience severe complications of the liver, which can lead to liver transplantation and, in extreme cases, liver-related deaths.

Challenges

Medications available to treat – or cure – HCV are expensive ($100,000 to $180,000 per treatment course) and can vary in tolerability and duration. If a patient does not properly adhere to the medication, the treatment becomes ineffective, which can result in additional medication expenses, viral resistance, disease progression and an increased risk of transmission of the infection to others.

Solution

Our strategies for cost containment and optimal outcomes include:

  • Prior authorization review to ensure the most effective HCV treatments are prescribed. Our HCV guidelines are developed with input from infectious disease specialists, and our extensive review process helps promote results-driven intervention and outreach strategy.

  • Medication adherence tracking to ensure that patients properly administer and complete the prescribed treatment course.

  • Prescriber outreach and education to discuss cost-effective therapies, improve medication adherence and gather outcomes regarding treatment plans and their effectiveness.

  • Outcomes analysis and reporting to assess and build upon strategies for medication use and adherence, collect outcomes on cure rates, and determine cost-avoidance.

Results

The Clinical Pharmacy Services division works with state Medicaid programs to develop effective models for handling high-cost medications. Most recently, we were able to achieve the following results for Hepatitis C Therapeutic Class Management in one New England state:

  • Recommended therapies were completed by 111 members.

  • Cost avoidance is projected to be $3,841,065 – approximately $34,604 per member.

  • We generated more than $10 in savings for every $1 spent on the program, including startup and maintenance costs.