Overview of Comprehensive Hepatitis C Virus Medication Management in a State Medicaid Program

Area of Science:

• Pharmacoeconomics
• Health Services Research
• Infectious Disease Management

Background:

• Direct-acting antivirals offer high cure rates for Hepatitis C Virus (HCV) but pose significant cost challenges.
• The healthcare system faces financial strain due to the high price of advanced HCV medications.

Purpose of the Study:

• To evaluate a comprehensive HCV medication management program's impact on optimizing drug regimens.
• To assess the program's effectiveness in modifying prior authorization (PA) processes.
• To quantify medication cost avoidance and return on investment (ROI) within a state Medicaid program.

Main Methods:

• Implemented a two-tiered prescriber outreach program: regimen optimization and refill adherence support.
• Developed PA criteria based on patient, viral, and cost factors to identify optimal regimens.
• Tracked PA modifications and calculated cost avoidance for completed treatments with optimized regimens.

Main Results:

• Over 900 PA requests were approved; 24.5% were targeted for regimen outreach, with 60.5% acceptance.
• Prescriber outreach for refills informed offices for 515 members, resulting in a 19.6% PA modification rate.
• The program achieved a projected cost avoidance of $3,770,097 and an ROI of $10.28 per $1 spent.

Conclusions:

• A comprehensive HCV medication management program effectively controls costs.
• The program ensures patient access to the most clinically appropriate and cost-effective HCV treatment regimens.