Anyone reading the Express Scripts Drug Trend Report will be struck by what happened last year with hepatitis C medications: national spending increased 194%. What does this signal for future years?
More than three million patients in the U.S. have chronic hepatitis C, with genotype 1 accounting for approximately 75% of all cases. Hepatitis C is a serious condition – in the U.S., it is the most common cause of cirrhosis of the liver, cancer of the liver, and liver transplant. More Americans died from hepatitis in the last decade than from HIV, and medical costs for hepatitis C are expected to double over the next 20 years (to $85 billion) as baby boomers begin to suffer health problems from chronic hepatitis C infection.
Last year’s spending increase for hepatitis C medications was primarily driven by the market entry of two new oral protease inhibitors, Incivek™ (telaprevir) and Victrelis™ (boceprevir). Both of these drugs were approved in May 2011 to treat patients with genotype 1 hepatitis C. These medications represent a true breakthrough in the treatment of hepatitis C and have the potential to save both lives and medical costs for patients who successfully complete medication therapy and are cured of this disease.
However, the new medications are costly. And choosing the right drug requires careful pharmacogenomic testing to determine which genotype of hepatitis C is present to ensure that each patient receives the most clinically appropriate treatment.
Are hepatitis C drug costs at their peak?
In a word… No. We’re currently forecasting that hepatitis C drug costs will continue to increase at very high rates in 2012-2013 as patients begin and complete therapy using these novel medications. In 2014, we expect spending to climb further with the entry of a new wave of oral, direct-acting antiviral medications.
What can plan sponsors do to minimize their own spending?
Express Scripts offers utilization programs that ensure that pharmacogenomic testing has been completed prior to the medication being dispensed. Also, dispensing these medications is less expensive when handled through the Express Scripts specialty pharmacies, Accredo and CuraScript. Finally, since adherence to these medications can be difficult for many patients, our HepLogic program helps ensure appropriate use of these medications and helps these patients complete their therapy.