Solving the Hepatitis C Drug Adherence Dilemma

Walgreens official discusses programs and techniques for improving patient adherence.

Within the rapidly changing hepatitis C treatment landscape, the high cost of breakthrough medications makes drug adherence an issue of vital importance.

A recent study by Walgreens indicated that individualized support plans from specialty pharmacies can be a key factor in supporting treatment adherence. The study examined the therapy status of 946 hepatitis C patients receiving treatment while enrolled in an individualized support program with goals of easing treatment barriers and improving outcomes.

The study found 95% of patients in the study completed their medication program, while less than 1% voluntarily discontinued treatment.

Health care costs associated hepatitis C are projected to hit $9.1 billion by 2024, which is up from $6.5 billion in 2011, according to a March 2013 study that appeared in Hepatology.

Given the importance of support programs for adherence to high cost hepatitis C medications, Specialty Pharmacy Times conducted an interview with Walgreens Senior Director of Virology Glen Pietrandoni to discuss the challenges hepatitis C patients face and the fast moving treatment landscape.

SPT: What techniques does Walgreens use to keep patients adherent to high cost hepatitis C drugs?

Pietrandoni: With our hepatitis C specialized pharmacies, not only are we clinically trained, but we’re aware of the programs available to consumers to help offset the cost and co-pays that are associated with high cost prescriptions. On one hand there are manufacturer co-pay cards that generally come up to a certain limit to help patients with general co-pays, but sometimes on these specialty drugs the dollars can get pretty high. There are foundations out there that help people in these situations to pay some of those larger sums, so we can help coordinate first with the insurance, and then we look to co-pay cards from manufacturers and foundational support to get the co-pay as low as possible. As we know, the cost can be the factor between somebody being able to finish their therapy or not. We get that all set up in advance so the patient knows what they’re in for financially over the course of their medication.

SPT: What constitutes an effective individualized support plan to help the patient through the course of treatment?

Pietrandoni: In hepatitis we have shorter therapy durations, where old versions of therapy would go on 6 months to a year, now we’re looking at 8 weeks or 12 weeks. We still want to make sure the patient understands right up front what they’re in for with adherence, what does adherence mean and what are the side effects that are expected. We’re always looking at the patient holistically, and drug interactions. We also want to include the financial burden that maybe requires some planning for that patient throughout the year. We want to make sure there is a complete understanding of the whole picture before the patient starts, and that usually results in better outcomes because the conversation is happening in advance. So with the new oral therapies, all oral therapies, and short durations of 8 to 12 weeks, that patient is obviously more comfortable committing to that timeframe than situations where it goes on longer. People may have changes in insurance or other changes that could impact it, so being proactive about what to expect is the core foundation of the program.

SPT: What are the additional health care challenges that hepatitis C patients face throughout treatment?

Pietrandoni: Obviously people that have hepatitis C may have other comorbidities. If we’re thinking about the age cohort that’s impacted by hepatitis C, generally speaking it’s older people, or at times, people co-infected with HIV or other conditions. So we know when we’re dealing with the hepatitis C patients, it’s not just hepatitis C, and not just the prescription being prescribed for that condition, it’s in the context of a whole person that is dealing with possibly other conditions. So when we’re looking at those terms, we want to look at drug interactions and really go through adherence and understand that other health conditions have to be managed as well during the course of therapy. I think that is one of the advantages we provide.

SPT: Following the controversy that surrounded the high cost of Sovaldi, what impact have new treatments had on the hepatitis C drug market?

Pietrandoni: One of the things about Sovaldi is that in true clinical guidelines, Sovaldi is never used alone. It’s prescribed with other medications, sometimes it’s ribavirin and sometimes is pegylated interferon. Harvoni gives the advantage of being a single tablet regimen and I think that is a slightly different story. I’m not saying that any one treatment is better than the other, but what I am saying is that as a pharmacist managing patients, when we’re talking about a complete regimen in a single tablet, it’s a little easier to talk about adherence and manage them through that therapy. Whichever product is recommended by the provider and whichever product is prescribed, our programs do adjust for those and the specific needs of the patient in the context of their overall health care.

SPT: What goes into selecting the right therapy for the right patient?

Pietrandoni: That’s at the provider level, but some of the key issues that come up are the genotype of the patient, because in the US 75% of the population is genotype 1, which is a key determinant of which medication is prescribed, and also the length of therapy. Another issue is if the patient had prior treatment and if they’ve been successful with that treatment or if they had failures in the past. That’s also something to consider for which medication they take and the length of therapy. Certainly comorbidities like HIV and the concern for drug interactions and other health conditions might determine which drugs can and cannot be used.

SPT: How do you evaluate the cost of these medications in the short term vs. the long term cost of treating the disease?

Pietrandoni: The payers are obviously interested in that. The regimen cost is what’s more important than the specific drug. You have to consider the cost of liver disease, transplantation, and possibly cancer down the road with cirrhotic patients. All those things really do come into play when you look at the overall savings.

SPT: How does Walgreens approach patient care?

Pietrandoni: What Walgreens has that differentiates us is the Connected Care program, which is a clinical program that supports the patient holistically. We know there are a lot of specialty pharmacies out there that are focused on a specific health condition and we like to differentiate ourselves, I think, at the level of looking at the patient in the context of their specialty disease need and we like to look at that patient holistically.