Hepatitis C is one of the leading chronic blood-borne pathogens prevalent in the U.S. It is one of the top causes of liver disease and liver cancer. Current therapies to treat hepatitis C are expensive averaging around $9 billion annually for affected patients in the United States.1 With the release of Incivek® (telaprevir) and Victrelis® (boecprevir) in May of 2011, significant clinical benefits are finally being achieved with cure rates reaching from 60-80%. Relating specifically to employer costs, these drugs are expensive but they provide a significant reduction in long term health issues and costs that come with chronic hepatitis C. 1 With the recent release of even newer drugs and many more in the pipeline, the way in which hepatitis C is treated and affects employer plan costs are due to change again and more profoundly.
Individual care
Hepatitis C has proven to be difficult to treat because of several genetic variations within the virus. This barrier has prevented successful treatment regimens because each variation of the virus responds to each of the available drug therapies in a different manner. Prescribing practitioners need to know which variation of the virus they are treating to be effective. To this point, all methods in attempt to acquire this information have been slow and inaccurate, only further complicating patient treatment.
As of late June 2013, Abbott Laboratories pharmaceutical company has created FDA-approved, standardized testing, known as The Abbott RealTime HCV Genotype II. This new automated test can identify the specific genotype of the hepatitis C virus. This was a big step in treatment of Hepatitis C allowing doctors to quickly individualize treatment, allowing more efficient treatment for patients and better clinical outcomes. 3
Newer medications and better outcomes
A new generation of hepatitis C treatment drugs have started their release into the market, beginning with Gilead’s drug, Harvoni® (Ledipasvir/Sofosbuvir) as the first FDA approved combination pill for treatment of Hepatitis C. These newer drugs are proving to work more effectively, showing clinically higher cure rates ranging from 80% – high 90% versus previous rates ranging from 60-80% .5 The new therapies also provide a different focus involving a therapy regimen that is easier to manage by the patients and more tolerable with regards to side effects. Current therapies for Hepatitis C require treatments from 24-48 weeks and sometimes even longer. 4 With newer therapy options, duration of treatment lasts only about 12-16 weeks and the use of expensive concurrent interferon therapies are being weaned out of the treatment regimens. 5
Better treatment leads to more demand for treatment which plays a role for employers and plan holders. It is estimated that the future number of patients seeking treatment could increase up to ~150,000 patients because of the new generation of hepatitis C medications. This is a 76% increase from the ~85,000 patients seeking treatment in 2012. This dramatic increase takes into account an increased recognition by those who are aware they are infected and also by use of these more effective and better tolerated drug regimens. It is thought that some practitioners are even intentionally delaying treatment hoping to start these patients on these new therapies arriving to the market. 1
Expensive costs but with great benefit
Most recently accepted treatment plans involving Incivek® and Victrelis® are already expensive ranging from $50,000-$100,000 over the course of treatment. With the release of Harvoni® in October 2014, the medication will cost about $1,125 per tablet. This brings the cost of therapy to about $94,500 per 12 week regimen.6
The shocking costs of the new therapies begs the questions: can these therapies possibly be cost efficient? Most health care costs by generated by hepatitis C infected patients are driven by the results of ineffective or untreated disease complications. End-stage liver disease, liver transplants, and cancer are the long term problems for patients infected with this virus. As study from 2011 on patients receiving Liver transplants showed costs averaging ~$577,000 per patient.7 With newer treatments becoming available, health care costs as a total for hepatitis C infected patients are expected to decrease over time. 1 As better cure rates are acquired from more successful treatment plans, more severe and costly complications of the disease are being avoided.
Additionally, there has been prospect that the new generation of hepatitis C medications may have sparked interest into this marketplace and may drive more competing manufacturers, allowing the prices to eventually decline. Contracting directly through a Pharmacy Benefit Manager will ensure the best possible prices will be reached through their market leverage and negotiation.
