Abstract

Background: Prior to July 2019, Hepatitis C (HCV) treatment was limited in the state of Louisiana due to restrictive prior authorization (PA) criterion for Medicaid patients. Ochsner Specialty Pharmacy (OSP), a health-system integrated pharmacy within the largest non-profit health system in the state was unable to fill most Medicaid HCV prescriptions and instead had to assist most patients with enrollment in the manufacturer assistance program with an uncertain amount of refill follow-up and pharmacist contact.

In July 2019, Louisiana entered a subscription-based contract which allowed Medicaid patients unrestricted access to authorized generic sofosbuvir-velpatasvir. Medicaid patients were now able fill their HCV treatment at OSP with close pharmacist follow up and contact. The primary outcome of this study was to determine the impact of specialty pharmacy on HCV medication adherence rates as determined by the proportion of days covered (PDC). Secondary outcome include the proportion of patients who achieve sustained virologic response (SVR), and time to treatment initiation.

Methods: This retrospective review of Medicaid patients with a diagnosis of HCV was collected from the electronic medical record between the dates of January 1, 2019 through December 31, 2019. Medicaid patients were included in the study if they were prescribed a direct-acting antiviral (DAA) by an Ochsner provider and were DAA treatment naïve. Patients were excluded if they had advanced levels of fibrosis, a history of transplantation, and did not complete or were deceased prior to the end of treatment.

Results: A total of 391 patients met all inclusion criteria (321 patients in the OSP group and 70 patients in the manufacturer group). For the primary outcome, patients in the OSP group saw a statistically significant increase in medication adherence as measured by PDC from 80.3% to 94% (p<0.05). In addition, time to treatment initiation decreased from 94 days in the manufacturer group to only 20 days in the OSP group (p<0.05). No significant difference was observed in SVR rates.

Conclusion: The close follow up and clinical services provided by OSP led to increased rates of HCV medication adherence. In addition, the unrestricted access to HCV treatment led to much shorter times to treatment. This study demonstrates the importance the additional clinical services provided by health-system integrated specialty pharmacists have on HCV medication adherence.