Cubic News

Breakthrough in the treatment of hepatitis C: treatment costs expected to more than double

October 2011

Two new oral protease inhibitors have been approved for the treatment of chronic hepatitis C: Incivek (telaprevir) and Victrelis (boceprevir). These drugs are considered breakthrough treatments for hepatitis C, offering a higher cure rate when added to peginterferon alfa and ribavirin – the current standard therapy for the disease.

These new drugs will not replace the current standard hepatitis C treatments, but rather will be used in conjunction with them. Therefore, adding Incivek or Victrelis will increase the cost of treatment, from the $28,000 level today, to as much as $75,000 once the estimated $45,000 cost of the protease inhibitors is added.

While these new drugs offer a much higher cure rate and can shorten the overall duration of treatment required for hepatitis C, plan sponsors need to be aware of the substantial impact these claims will have on plan costs in this area. As of yet, the industry is divided on how these new drugs will be covered.

Some Carriers are allowing their coverage without prior authorization, rationalizing that the treatment is short term and that these products will only be prescribed for the treatment of hepatitis C, meaning that prior authorization of these products product could be a rubber stamping exercise because off-label use is not expected. At the same time, other Carriers have added these products to their prior authorization lists due to cost and place in therapy considerations.

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