Impact of a high-touch, collaborative, patient-centric, hepatitis C specialty clinical program on completion of glecaprevir/pibrentasvir therapy

Abstract

Background: Hepatitis C (Hep C) is a liver infection caused by the Hep C virus. It is the most common, chronic, blood-borne infection in the US. It is estimated to affect as many as 3 million Americans and is the leading cause of liver transplants in the US. Hep C is often curable with newer antiviral therapy that is short in duration of treatment and more tolerable than traditional therapies. Aims: To measure the impact of a high-touch, specialty clinical program on driving therapy completion of glecaprevir/pibrentasvir in Hep C patients. Methods: This study was performed from a single center specialty pharmacy (SP). We evaluated patients initiating glecaprevir/pibrentasvir from February to March 2019. The outreach strategy included onboarding new-to-therapy patients by pharmacy technician specialists through the completion of a “Welcome Call”. The technician specialists determined the best time with every patient’s input for the pharmacist to follow up with a “New Start Pharmacist Initial Counseling Call”. A clinical pharmacist completed the Hep C counseling call. Afterward, a nursing refill reminder call was completed. Also, a “Patient Care Coordinator Refill Reminder Call” was coordinated to set up the shipment of the medication. After the patient completed their final refill, a nurse generated an “End of Therapy Call” to determine whether completion of therapy occurred. Results: Of the 46 patients managed by the SP, 44 patients received the cumulative days’ supply required to complete therapy. The SP had a 100% completion rate of therapy for the patients that were eligible to continue therapy. Two patients, due to allergic reactions, were not eligible to complete therapy. As such, this resulted in an overall completion rate of 96%. All patients received an initial counseling call. Thirty of the 46 patients received refill reminder calls from a nurse; 16 patients were not eligible for this call due to the patient reaching out to the pharmacy prior to the refill reminder call for their shipment, refill not applicable or allergies to the medication. Forty-four patients had end-of-therapy calls completed. Conclusions: A collaborative, high-touch SP, managing Hep C patients, drove a high rate of completion of glecaprevir/pibrentasvir Hep C therapy (100% of patients eligible). Specialty pharmacies that demonstrate improved Hep C completion rate outcomes with robust, coordinated care processes can be more confident in building future value-based reimbursement models with payers and pharmaceutical manufacturers.