Local specialty pharmacy and specialty clinic collaboration assists access to hepatitis C direct-acting antivirals Journal Article

Authors: Zhu, J.; Hazen, R. J.; Joyce, C; Delpino, A.; Kirkham, H. S.; Strickland, C. D.; Markes-Wilson, S.; Kim, T.; Kang, M.; Rubin, R. A.; Stein, L. L.
Article Title: Local specialty pharmacy and specialty clinic collaboration assists access to hepatitis C direct-acting antivirals
Abstract: OBJECTIVES: To measure prescribed time to therapy (TtT) and sustained virologic response (SVR). Secondary objectives were to assess insurance appeals and copay assistance amount facilitated by a local specialty pharmacy (LSP). METHODS: This descriptive, retrospective study used a joint clinical and pharmacy database of patients who were prescribed direct-acting antivirals (DAAs) at a single-center liver specialty clinic and received LSP services from December 2013 to December 2015. RESULTS: Among 388 patients prescribed DAAs, 364 (94%) patients, who were 18 years of age or older, initiated DAA therapy, and received LSP services, were included in the study. Of these, 211 (58.0%) had cirrhosis, 159 (43.7%) had previous treatment, and 57 (15.7%) had previous liver transplants. Most patients had commercial insurance (n = 249; 68.4%), and 295 (81.0%) required prior authorization. Insurance initially denied coverage to 70 patients (19.2%), for who the LSP drafted appeals for 60 (85.7%). Copay information was available for 154 LSP patients. Although 66 had initial copays of more than $20 per month, the LSP was able to assist most (98.1%; n = 151) with copay reductions to $20 or less. Full financial assistance was received for 20 patients without insurance or any DAA coverage. Among 171 patients with SVR and prescribed TtT information, mean TtT was 12 days (median 4 days), and most received medications within 10 days (n = 122; 71.3%). The overall intention-to-treat SVR rate was 86.8%; the per-protocol (PP) SVR rate was 93.8%. CONCLUSION: Collaboration between providers and an LSP minimized delay in therapy, lowered rates of DAA denial, facilitated patient financial assistance, and helped to optimize clinical outcomes. The PP-SVR rate for this study was similar to rates reported in the literature and higher than expected, considering the inclusion of earlier-generation DAAs and many patients with advanced liver disease.
Journal Title: Journal of the American Pharmacists Association : JAPhA
Volume: 58
Issue: 1
ISSN: 1544-3450; 1086-5802
Publisher: American Pharmacists Association(R). Published by Elsevier Inc  
Journal Place: United States
Date Published: 2018
Start Page: 89
End Page: 93.e2
Language: eng
Notes: LR: 20180101; CI: Copyright (c) 2018; JID: 101176252; 2017/05/01 00:00 [received]; 2017/10/17 00:00 [revised]; 2017/10/19 00:00 [accepted]; 2017/11/21 06:00 [pubmed]; 2017/11/21 06:00 [medline]; 2017/11/21 06:00 [entrez]; ppublish