Protease Inhibitors for Hepatitis C

Cincinnati—For pharmacy benefit managers, managing hepatitis C virus (HCV) protease inhibitors present significant challenges, including high costs, treatment complexity, and increased adverse events. RegenceRx Pharmacy Benefit Management in Portland, Oregon, developed a prior authorization approval process aimed at reducing costs, managing adverse events, and improving adherence. The approval process considers members’ HCV genotype, prior treatment history, and response to treatment. The program presented telaprevir as a preferred alternative to boceprevir, unless contraindicated.

RegenceRx presented an analysis of its process during a poster session at the AMCP meeting. The poster was titled Opportunities to Improve a Hepatitis C Protease Inhibitor Management Program. The objective of the study was to describe the RegenceRx member population using HCV protease inhibitors and to identify opportunities to improve the HCV management program.

The study was a retrospective review of RegenceRx prescription claims and prior authorization databases from September 30, 2011, through July 15, 2012. All members of the RegenceRx plan who received prior authorization approval for boceprevir or telaprevir were included in the analysis.

In the analysis of claims, 4 groups were identified: (1) those currently on HCV therapy, (2) those who had completed HCV therapy, (3) those with no paid prescription claims for an HCV protease inhibitor, and (4) those with incomplete paid claims. Medication costs were assessed using prescription claims data. The data included average cost per prescription; total prescription costs for HCV protease inhibitors, peginterferon, and ribarivin; and costs associated with medication waste due to early treatment discontinuation. Clinical information for members who had no paid claims or incomplete paid claims for HCV protease inhibitor therapy was collected through prescriber surveys.

Of the member population, a total of 101 members received prior authorization approval for boceprevir or telaprevir. Telaprevir accounted for 96 (95.0%) of these approvals, which was expected due to RegenceRx’s preference for the therapy in the prior authorization policy. Of the 101 members, 53 were currently being treated (31 never treated in the past, 21 with previous treatment history); 17 had completed therapy (8 never treated, 9 previously treated); 18 had no paid claims (9 never treated, 9 previously treated); and 13 had incomplete paid claims (5 never treated, 9 previously treated). Those members with incomplete claims were most commonly previously treated (61.5%), suggesting a need for support in improving adherence.

Of 31 prescriber surveys, 18 were for members who had no paid claims and 13 were for members who had incomplete paid claims. Financial concerns were seen to be a barrier to optimal clinical benefit with HCV protease inhibitors; the most common reason for having no paid claims was financial concerns (61.1%), and of those members with no paid claims, 33.3% started therapy with financial help from the manufacturer. Early discontinuation of therapy was mainly due to adverse events (46.2%).

For those members who completed telaprevir therapy (n=16), the average total cost of HCV therapy per member was $67,018. No member had yet completed boceprevir therapy at the time the study was conducted. The cost associated with telaprevir waste was $11,080 per member (n=6). There was no medication waste cost associated with boceprevir (n=2). The authors said that medication costs and adverse events were the driving factors for prescriptions that were not being billed. They suggested that developing ways to decrease medication waste could improve management of HCV protease inhibitors.

This study was supported by Gilead Sciences, Inc.