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

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    Authors
    Lavitas, Pavel
    Tesell, Mark A.
    Hydery, Tasmina
    Greenwood, Bonnie C.
    Price, Mylissa K.
    Lenz, Kimberly J.
    Jeffrey, Paul L.
    UMass Chan Affiliations
    Commonwealth Medicine, Center for Health Policy and Research
    Commonwealth Medicine, Clinical Pharmacy Services
    Document Type
    Journal Article
    Publication Date
    2016-10-01
    Keywords
    Hepatitis C Medication Management
    Medicaid
    Pharmacy
    Health Services Administration
    Health Services Research
    Pharmacy Administration, Policy and Regulation
    Virus Diseases
    
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    Link to Full Text
    http://dx.doi.org/10.18553/jmcp.2016.22.10.1161
    Abstract
    BACKGROUND: Breakthrough direct-acting antivirals set a new standard in the management of hepatitis C virus (HCV) with regard to cure rates and improved tolerability; however, the health care system is challenged by the cost of these medications. OBJECTIVE: To describe the effect of a comprehensive HCV medication management program on optimized regimen use, prior authorization (PA) modifications, and medication cost avoidance in a state Medicaid program. METHODS: This program consists of a 2-tiered prescriber outreach: (1) regimen outreach to promote optimized regimen selection and (2) refill outreach to support medication adherence. PA criteria were developed to identify optimized regimens, taking into account member- and virus-specific factors as well as cost. Prescriber outreach was conducted to recommend the use of an optimized regimen as applicable. Successful regimen outreach was defined as the number of members for whom a recommendation was accepted. A refill report identified members without a subsequent paid HCV medication claim within 25 days of the previous claim and outreach to the prescriber's office was performed. The outcome measure for refill outreach was the number and type of PA modifications made secondary to outreach (closure or extension). Cost avoidance was calculated for members who completed treatment with an optimized regimen. Return on investment (ROI) was calculated for the program. RESULTS: Between December 18, 2013, and January 31, 2015, 911 members had PA requests approved for simeprevir, sofosbuvir, or ledipasvir/ sofosbuvir. Of these members, 223 (24.5%) met the criteria for regimen outreach. Pharmacist interventions to treat with an optimized regimen were accepted for 135 members (60.5%). Following implementation of prescriber outreach to promote refills, between March 10, 2014, and January 31, 2015, offices were informed of an upcoming refill for 515 members. As a result of outreach, 19.6% of members had a subsequent PA modification. Sixty-nine approved PAs (for 68 members) were closed after correspondence with the prescriber, and 33 approved PAs (for 33 members) were extended. The total projected cost avoidance was $3,770,097. The comprehensive HCV medication management program demonstrated an ROI of $10.28 for every $1 spent. CONCLUSIONS: A comprehensive HCV medication management program can help contain costs while ensuring that members have access to most clinically appropriate regimens.
    Source
    J Manag Care Spec Pharm. 2016 Oct;22(10):1161-6. doi: 10.18553/jmcp.2016.22.10.1161. Link to article on publisher's site
    DOI
    10.18553/jmcp.2016.22.10.1161
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27043
    PubMed ID
    27668564
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.18553/jmcp.2016.22.10.1161
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