AJMC Panelists Discuss How Discounts Should Expand HCV Treatment: “It Really Is Time to Treat Everyone”

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A year after Sovaldi’s $1,000-a-pill price tag set off a national discussion, new entrants in the market to cure the hepatitis C virus have allowed pharmacy benefit managers to bring down its cost for health plans. Experts convened by The American Journal of Managed Care said this should expand who gets treatment, but they also say this won’t be last of the high-cost specialty drugs.

AJMCtv Panel Discussions bring together viewpoints of providers and payers on current topics.

New entrants to compete with Sovaldi mean commercial payers and Medicaid can back away from policies that limit treatment to hepatitis C patients with the most advanced disease.

A year after Sovaldi made headlines at $1,000 a pill, new entrants in the drug class that cures the hepatitis C virus (HCV) have allowed pharmacy benefit managers to negotiate exclusivity deals and steep discounts, which should allow broader access to these drugs than was the case in 2014, according to a panel convened by The American Journal of Managed Care.

The December approval of AbbVie’s Viekira Pak, which competes with the combination therapy Harvoni and first-in-class-Sovaldi, both by Gilead, will lead to market wide savings of $4 billion, according to Steven Miller, MD, MBA, senior vice president and chief medical officer at Express Scripts (including an estimated $1 billion for Express Scripts clients alone).

Multiple HCV options allowed pharmacy benefit managers to take aggressive actions to bring savings for health plans. While this may require some patients to start on one specific therapy, the end result will ultimately be good for the HCV population as whole, the panelists said. Payers—including state Medicaid officials—can now back away from policies of only treating those with the most advanced disease. “It really is time to treat everyone,” Miller said.

Taking part with Miller were Ed Cohen, PharmD, FAPhA, senior clinical director, Walgreens; Matthew D. Harman, PharmD, MPH, director, Clinical Pharmacy Strategies, Employers Health; and Keith Hoffman, PhD, vice president for Scientific Affairs at Adverse Events. Surabhi Dangi-Garimella, PhD, managing editor of AJMC’s Evidence-Based Series, served as moderator.

The wide-ranging discussion covered the role of formulary management in bringing about this change, how data on the new class of HCV drugs will drive future decisions, and what’s coming in specialty pharmacy. Panelists also discussed reviewing drugs to be included on formularies based on total cost of care, which includes adverse reactions, as these can affect downstream costs of therapies. To hear the full discussion, click here.

When it was approved in December 2013, Sovaldi was hailed as a breakthrough. Unlike past treatments that could only treat HCV—often with unpleasant side effects—this once-a-day pill could cure 95% of patients, eliminating future medical costs that could include a liver transplant. But the $84,000 cost of a 12-week treatment course, coupled with an estimated patient population of 3.2 million, staggered health plans and Medicaid officials, especially when it was recommended that everyone born between 1946 and 1964 be screened for the disease.

Competition in the class provides some breathing room, but even with more choices on the way, Cohen did not believe drug prices would fall much lower. But the point is, he said, is that these are cures for HCV. “The overall therapy to save a life—how do you put a price on it?”

The AJMC panelists discussed the fact that Viekira Pak works differently. Its FDA approval states that it works “with or without ribarivirin,” and requires 2 different pills a day. The panelists said the pharmacy field will be watching adherence data closely over the next year to see how Viekira Pak fares.

By year’s end, Hoffman said, “if there are differences, and if people see adherence issues, clearly those will be some interesting comparisons to make. Hopefully there will be formulary decisions that are appropriate.”

Lessons from the HCV Experience

Panelists described the challenge of Sovaldi as one of “orphan drug pricing” even though HCV is not an orphan disease. They agreed this is just the beginning. It’s being seen in new immuno-oncology drugs to fight cancer and in the new class of PCSK9 inhibitor drugs for cholesterol that will arrive this summer.
Harman questioned whether the healthcare system can sustain the trend of “specialization of traditional drug classes,” which he said could affect not only areas such as HCV, which involves a one-time cost with a cure, but also chronic conditions such as asthma or diabetes.

Panelists agreed that the trend has implications not only for costs, but also for the role of community pharmacy, as more drugs fall into the “specialty pharmacy” realm. “It will be very interesting to see the effect,” Cohen said.

About the Journals

The American Journal of Managed Care celebrates its 20th year in 2015 as the leading peer-reviewed journal dedicated to issues in managed care. Other titles in the franchise include The American Journal of Pharmacy Benefits, which provides pharmacy and formulary decision-makers with information to improve the efficiency and health outcomes in managing pharmaceutical care, and The American Journal of Accountable Care, which publishes research and commentary on innovative healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s Evidence-Based series brings together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

CONTACT: Nicole Beagin (609) 716-7777 x 131
     nbeagin(at)ajmc(dot)com
     http://www.ajmc.com

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