Apr 8, 2014

Specialty Trend Forecast: Hepatitis C

Spend for hepatitis C medications is expected to increase more than 100% in 2014 and at least 200% in both 2015 and 2016.
Trend for medications used to treat hepatitis C is forecast to be 102.0% in 2014, 208.8% in 2015 and 205.0% in 2016.

Decreasing utilization of hepatitis C medications in 2013 led to a significant decrease in spend, which dropped the medications out of the top 10 specialty therapy classes when ranked by per-member-per-year (PMPY) spend. However, substantial increases in utilization and brand inflation in the next few years are expected to contribute to triple-digit PMPY trend. Utilization decreases were in response to the warehousing of currently untreated hepatitis C patients in anticipation of the launch of new, oral regimens that either reduce the length of treatment with pegylated interferon and ribavirin or even entirely eliminate the need for pegylated interferon.

PMPY spend is expected to rebound in 2014 as a result of the late-2013 launch of two new medications, Olysio™ (simeprevir) and Solvaldi™ (sofosbuvir). Both drugs have been shown to increase sustained viral response rates and reduce the overall length of therapy. The cost of treatment using these add-on drugs is expected to range from $80,000 to $100,000 per course of therapy, not including the costs of pegylated interferon/ribavirin combinations. The development pipeline also includes all-oral regimens for genotype 1 patients (by far the most common genotype in the U.S.), which are expected to be launched at the end of 2014. These oral regimens carry the promise of easier dosing, shorter lengths of therapy, increased tolerability and improved efficacy.