Last week CVS released data via their CVS Health Research Institute announcing that they found over 8% of Hepatitis C patients on Gilead’s Sovaldi
are failing to complete their treatment and treated this as breaking news.
Sovaldi has had an amazing year. It burst onto the market with a cure rate of nearly 90%. Sovaldi also decreased the length of treatment to 12 weeks with a low side effect profile. All fantastic news.
With it’s $84,000 price tag and the large patient population it quickly attained blockbuster status and stirred debate. This unleashed a debate among insurers, government agencies and politicians about how to pay for treatment. A description of the debate can be found at the Washington Post’s Wonkblog.
Prior to Sovaldi, treatment of Hepatitis C was a daunting task for patients to drive the virus to “undetectable levels” (that description avoided debates about a cure). A Hep-C patient faced a long (24 to 48 weeks), expensive treatment plan with a significant side effect profile. For these reasons, it became a disease state almost exclusively managed and dispensed by specialty pharmacies.
Specialty pharmacies focus on rare or difficult to treat diseases states. Their reason for being is to ensure patients successfully navigate the complexities of access to drug, insurance coverage and full course of treatment. Specialty pharmacies have historically started patients on treatment and motivated them to continue treatment better than in a retail setting.
The hallmarks of specialty pharmacy are:
- Specialize knowledge of rare and difficult diseases
- Patient education about the disease and goals of treatment
- Assistance with insurance documentation and coverage
- Locating financial assistance for patients in need
- Ensuring patient adherence to the drug treatment
So what happened with Sovaldi? A shorter and safer treatment should have been easier, and that may be the trap.
While there will always be individuals who drop off treatment, could some of the 8% have been kept on Sovaldi with focus on the patients at risk? Yes, but how many more will be up to specialty pharmacies and the types of educational and informational interventions they set up.
Did the specialty pharmacies take their eye off of Hep-C because it appeared to be an easier category? Some evidence lies in CVS’s bland statement about their findings.
In their report, CVS states “Sovaldi is an effective, curative therapy but also a costly one, and Sovaldi treatment discontinuation represents a substantial cost to the health care system without the corresponding clinical benefit and value. Our data suggest that all patients who receive Sovaldi should be followed closely by their providers to support adherence to therapy.”
That statement could and should be associated with every treatment advance in Hepatitis C since treatment became possible and specialty pharmacies stepped in to improve patient outcomes.
The good news is that 92% are completing treatment. The better news would be to drive the 8% drop off down with education, and a coordinated approach with all stake holders.
Again, what happened with Sovaldi? Wrong question. It puts a negative spin on all the positive. The right question is how can all stakeholders improve on adherence and persistence with Hepatitis C treatment?