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Despite discounts for hep C meds, noncompliance, coverage denials rise

March 8, 2017

Trio Health today announced interim data from its real-world tracking platform that shows Hepatitis C drug treatment non-starts growing from eight percent in 2014 to over 30 percent in 2016, predominantly due to payer coverage denials. The data show that while the number of treated patients continues to decrease, the total number of patients seeking treatment for their condition continues to grow each year.

“There are no other disease states that I’m aware of where curative therapies are increasingly withheld from patients who are covered by commercial insurance plans, Medicaid or Medicare,” commented Nezam Afdhal, M.D., Professor of Medicine, Harvard University, and Chairman of Trio Health’s Scientific Steering Committee. “What is most surprising is that this trend is growing even though treatment cure rates are now above 90 percent, duration of therapy has been reduced to as little as eight weeks for the majority of patients, and real treatment costs are one-third lower than just a few years ago. In almost any other commercial setting, this would result in a significant expansion of market access, but with Hepatitis C, we’re seeing fewer patients receive care even though the number of patients seeking treatment continues to grow.”

Highlights of the findings include:

Rates of non-starts of direct antiviral agents for Hepatitis C increased each year starting in 2014. They were observed for all payer types and regardless of disease severity. For 2016:

  • 37% of patients with no-to-moderate disease (F0-F2) did not start treatment after being prescribed therapy
  • 24% of patients with severe-to-cirrhotic disease (F3-F4) did not start treatment after being prescribed therapy

Under commercial insurance coverage, a worsening trend was observed for patients with severe fibrosis/cirrhotic disease in 2016:

  • 39% of patients with no-to-moderate disease (F0-F2) did not start treatment after being prescribed therapy
  • 36% of patients with severe-to-cirrhotic disease (F3-F4) did not start treatment after being prescribed therapy

Under 2016 Medicaid coverage:

  • 64% of patients with no-to-moderate disease (F0-F2) did not start treatment after being prescribed therapy
  • 34% of patients with severe-to-cirrhotic disease (F3-F4) did not start treatment after being prescribed therapy

Under 2016 Medicare coverage:

  • 17% of patients with no-to-moderate disease (F0-F2) did not start treatment after being prescribed therapy
  • 13% of patients with severe-to-cirrhotic disease (F3-F4) did not start treatment after being prescribed therapy

Complete results will be presented Wednesday, March 8 at 12:15pm EST. To listen to the presentation/webcast visit: http://triohealth.troutgroup.com.

“We built the Trio Health Network to provide a representation of real-life treatment for HCV across the U.S.,” commented Brent Clough, President and CEO of Trio Health. “Our ability to track the course of a physician’s prescription to pharmacy to payer opened for the first time a direct view of the demand for therapy and when a patient fails to start treatment due to coverage denials. We believe this information is critical to understanding the delivery and utilization of healthcare across the U.S., regardless of coverage. We look forward to providing updated figures on HCV throughout the year.”

The study evaluated use of all direct acting antiviral agents, including Sovaldi®/Harvoni® (Gilead), Viekira Pak™ (Abbvie), Zepatier™ (Merck), Daklinza™ (BMS) and Epclusa® (Gilead).

Trio Health has collected real-world evidence on 15,000 HCV patients and published over 30 studies since the launch of the direct antiviral agent in 2014.

http://bit.ly/2m0A1HX

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