Rapid expansion of HCV drugs, treatment population signal need for cost controls

A new report found that prescriptions for ledipasvir and sofosbuvir, the newest hepatitis C treatment, are growing rapidly but the minimal reduction in sofosbuvir prescriptions indicates an overall expansion of the eligible treatment population rather than the former drug replacing the latter, according to a press release.

“The high price of these new hepatitis C treatments and the expanding pool of patients receiving treatment signal a growing and costly trend in treating chronic medical conditions with specialty medicines,” Troyen A. Brennan, MD, chief medical officer of CVS Health and report co-author, said in a press release. “Hepatitis C is just the beginning, and we need to prepare now for the time when large numbers of patients could be treated effectively with high-cost medicines for a variety of common and more complex conditions.”

Using CVS/caremark data, the report compares prescriptions for ledipasvir and sofosbuvir (Harvoni, Gilead) with prescriptions for sofosbuvir (Sovaldi, Gilead) during the 8-week period following the launch of each treatment, the release said. The authors found that post-launch prescriptions for ledipasvir and sofosbuvir exceeded 7,500, which is an estimated 2.5 times greater than the 3,000 prescriptions for sofosbuvir. Furthermore, they found that sofosbuvir use has only declined minimally since the launch of ledipasvir and sofosbuvir, suggesting an overall expansion of the eligible treatment population and high utilization of each drug.

“As new therapies enter the market, particularly in categories such as hepatitis C where treatment costs are high, CVS Health is focusing on strategies to control costs while improving patient health outcomes,” Alan Lotvin, MD, executive vice president of CVS/specialty at CVS Health, said in the release. “These will include utilization management and formulary approaches to ensure the most cost-effective, clinically appropriate therapy. We also provide comprehensive, patient-centered support to maximize the successful completion of therapy.”

The company has developed a number of cost and patient outcome management tools in light of the impact of high-cost specialty medications on payers’ budgets, the release said. For HCV in particular CVS/caremark “coordinates utilization management and prior authorization strategies to drive evidence-based decision-making … in order to optimize efficacy and reduce unnecessary costs.” Price negotiation on future treatments as they enter the market is also key, the release said.