The Northwell Health Real World Experience : A novel team approach is successful in overcoming barriers of access to obtaining HCV direct acting anti-viral therapies and obtaining SVR rates of 97%
AASLD LiverLearning®. Lee S. Nov 14, 2016; 144624
Topic: Practice Issues
Label: Health Care Delivery/Access/Quality
Dr. Susan Lee
Dr. Susan Lee

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ABSTRACT FINAL ID: 1732

TITLE: The Northwell Health Real World Experience : A novel team approach is successful in overcoming barriers of access to obtaining HCV direct acting anti-viral therapies and obtaining SVR rates of 97%

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ABSTRACT BODY:
Introduction: Hepatitis C (HCV) is almost universally curable. The greatest barrier to cure has become patient (pt) access to direct acting anti-viral (DAA) therapies due to non-medical restrictions imposed by payers. In order to overcome these restrictions and obtain access to therapy for all patients (pts), we center created a dedicated team to work on behalf of our HCV pts.
Methods: We created a team comprised of a pharmacist, pharmacy technician, patient navigator and physician whose responsibilities included DAA acquisition and delivery, patient education, and data collection. DAA acquisition included completing prior authorizations and letters of appeal to payers and the NY State external review board. The program was piloted in a single office and then expanded to multiple sites in the New York area.
Results: We report initial results for the period 1/1015-6/6/2016. During that time, 917 pts with HCV entered our process for DAA acquisition. Pts with all insurances including 20 commercial plans, 12 managed Medicaid plans and straight Medicaid were included. Medication was requested for all pts regardless of fibrosis stage and genotype. During the evaluated period, 810 pts were approved for treatment (88%), 764 have received medication (83%), 107 patients still have final approval/denial pending. 3/917 patients have had their DAA treatments denied (<1%). As of 6/6/2016, 46 pts were approved but did not start therapy. Reasons for not starting included: needing counseling by PharmD(19), personal reasons such as surgery, vacation (18), and needing medication delivery(9). Of our approved cohort, 454 were treatment-naïve and 356 treatment -experienced. Genotype breakdown: G1 not subtyped 3, G1a 483, G1b 237, G2 33, G3 41, G4 12, G6 1. Fibrosis score by biopsy or Fibroscan: F0 25, F1 241, F2 130, F3 89, F4 272. 53 patients had no fibrosis score. Approved DAA's were: SOF/LDV+ ribavirin (RBV) 639, Sofosbuvir(SOF)/RBV 42, PrOD + RBV 91, Daclatasvir/SOF+RBV 31, ELB/GZR + RBV 5, PrO+ RBV 2.
As of 6/6/2016, 664 patients completed therapy. Approximately 190 patients are in the follow period. SVR rate for the completed patients is ~97%. To date, 18 patients have relapsed following cessation of therapy.
Conclusions: Implementation of a dedicated team to obtain access to HCV DAA therapies overcomes standard barriers to treatment access and greatly improves the ability to obtain these treatments for all pts with HCV, regardless of insurance, fibrosis stage or genotype with overall medication acquisition 88% and absolute denial rate < 1%. Outcomes from this program include SVR rates of 97%, improved patient satisfaction scores and improved staff experience.
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