Tool: How to Calculate Your Organization’s Future Hepatitis C Spend

Sep 19, 2014
The Express Scripts Lab and Accredo launched an intuitive online calculator enabling health plan sponsors to explore the impact of rising hepatitis C medication costs and find opportunities to reduce costs. View the tool at
  • Hepatitis C

By 2016, spending on hepatitis C medications will exceed that of medications for much more common conditions, including high blood pressure and high cholesterol. The explosive drug trend is led by new therapies that cost $1,000 a day, sometimes more than $100,000 per patient, and are taking a premium on already inflated treatment costs. For employers and health plans, these costs are unprecedented and unsustainable.

No therapy class has experienced such a high spending increase in the 21 years we’ve measured drug trend data.

Explore the Impact of Rising Costs

A retrospective look at claims data provides a good measure of how much treating hepatitis C has cost plan sponsors in previous years. However, until now, it has been difficult to gauge the impact that new, hugely expensive drugs such as Sovaldi will have on payers’ bottom lines. Researchers and clinicians from the Express Scripts Lab and Accredo Specialty Pharmacy have developed a new online tool, the Hepatitis C Plan Cost & Trend Calculator, to help payers analyze how much their costs may increase.

Payers can access the tool at The calculator enables employers and health plans to calculate estimated plan costs for hepatitis C through 2016, after only inputting a few basic attributes, including:

  • Number of members
  • Percentage of members by plan type
  • Per member per year (PMPY) costs for 2013
  • Estimated percentage of members with hepatitis C that will be treated each year
  • Therapy regimen mix (optional)


With this information, the tool estimates how many members will develop chronic hepatitis C and stratifies them based on disease progression. Then, based on current cost estimates and the percentage of patients being treated, it calculates the overall costs and PMPY costs through 2016. Use these instructions for additional information about the tool.

The model will continue to be reviewed and updated as new drugs are launched, so it reflects the most accurate and up-to-date information (including pricing) available.

Users should have thorough discussions with their account teams to fully understand the impact of the new hepatitis C medications and how to help control costs.

Click here to download instructions for using the tool.

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Lab Staff
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