Universal testing, access to clinical pharmacist reduced barriers to HCV treatment

For patients with hepatitis C, universal screening and the integration of clinical pharmacists may improve access to direct-acting antiviral therapy and help patients achieve sustained virologic response, according to a poster presentation.

“We do know that there are several DAA therapies that are effective, safe, very well tolerated and help with achieving SVR. Despite having these treatments accessible, we do find that there are still barriers that limit successful uptake,” Ammie Patel, PharmD, BCPS, BCACP, clinical assistant professor at the Ernest Mario School of Pharmacy at Rutgers University, said during a presentation at The Liver Meeting Digital Experience.

Some of the barriers to HCV treatment include drug-drug interactions, medication costs, and required prior authorizations, which reduce medication accessibility, according to Patel.

“We also find that because of these reasons, a scale-up of chronic HCV screening, as well as linkage-to-care and pharmacist integration, may be catalytic in helping to achieve HCV elimination. Our aim was to demonstrate the impact of the clinical pharmacist within the internal medicine practice for HCV care as well as treatment,” Patel said.

Patel and colleagues screened 61,914 individuals for HCV from March 2018 to August 2021. Patients with HCV were contacted by patient navigators and provided linkage-to-care for therapy and evaluation by primary care physicians. Physicians would then provide linkage to clinical pharmacists who were consulted to recommend HCV therapy, complete prior authorization, apply for financial assistance, monitor laboratory parameters, counsel patients on medication adherence and side effects and follow for cure.

Of the patients screened, 1.9% were positive for HCV antibodies and 0.5% were positive for HCV RNA. Of the 302 patients with a current HCV infection, 48.7% were newly diagnosed. The linkage-to-care rate for patients was 86.8%.

Of the patients evaluated by the PCP, 39 initiated therapy, and the incorporation of clinical pharmacists led to the completion of 37 required prior authorizations and drug approvals. The clinical pharmacist also secured copay assistance and foundation support for 16 patients who required financial assistance and both identified and mitigated drug-drug interactions with DAAs in 11 patients. SVR was achieved at 12 weeks post-therapy in 36 patients.

“In conclusion, we did find that automatic universal screening was an effective way to scale up the screening, and the warm handoffs from patient navigators to the rest of the team was important for engaging these patients. We also found that the integration of clinical pharmacist services within our program has contributed to dismantling the barriers of HCV cure, including all of the reasons listed earlier, like cost, access, drug interactions, adverse reactions, as well as nonadherence,” Patel said.