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Survey Finds Most Primary Care Providers Unaware of New Hepatitis C Drugs

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Nearly 75% of primary care physicians are unfamiliar with the most recently approved direct-acting antiviral drugs for hepatitis C, and about two-thirds are unaware of even the first-generation antivirals available since 2011, according to a recent survey by Decision Resources Group.

The advent of direct-acting antivirals has revolutionized treatment of hepatitis C virus (HCV) infection in recent years. The former standard of care -- pegylated interferon plus ribavirin -- involved 24 to 48 weeks of treatment that required weekly injections and caused difficult side effects, but cured only about half of patients.

The addition of the first 2 HCV protease inhibitors -- boceprevir (Victrelis) and telaprevir (Incivek or Incivo), both approved in 2011 -- significantly improved sustained response rates, but introduced further side effects of their own.

Since then, newer DAAs, including next-generation protease inhibitors, polymerase inhibitors, and NS5A inhibitors, have raised cure rates above 90%. While adding these drugs can improve response to interferon-based therapy, the real breakthrough is all-oral regimens that can cure most people in as little as 8 to 12 weeks with few side effects. The first 2 next-generation agents -- sofosbuvir (Sovaldi) and simeprevir (Sovaldi) -- were approved in late 2013, and several new agents are expected by the end of this year.

But barriers to widespread use of these therapies remain, including the large number of people who are unaware they are infected with HCV, the high cost of the new drugs, and a lack of knowledgeable providers, as the recent survey illustrates.

Below is an edited excerpt from a Decision Resources Group press release describing the survey findings in more detail. The full report is available online.

Nearly Three-Quarters of Surveyed Primary Care Physicians are Unfamiliar with Approved Direct Acting Antivirals for Hepatitis C Virus

The majority of surveyed primary care physicians expect to refer HCV patients to a specialist for care, according to findings from Decision Resources Group

June 19, 2014 -- Burlington, Mass. --Decision Resources Group finds that less than one-third of surveyed primary care physicians (PCPs) are familiar with the first-generation hepatitis C virus (HCV) protease inhibitors, Vertex’s Incivek and Merck’s Victrelis, despite the fact that these direct acting antivirals have been marketed in the U.S. since 2011.

Furthermore, approximately three-quarters of surveyed PCPs are unaware that Janssen/Medivir’s Olysio and Gilead’s Sovaldi recently received FDA approval for the treatment of HCV infections, highlighting an opportunity for drug marketers to increase their prescriber pool by raising awareness of the current HCV treatment options among PCPs.

Other key findings from the U.S. Physician and Payer Forum report entitled: Primary Care Physicians in an Interferon-Free World: How Will the Availability of Safer and More Effective Oral Therapies Impact the Role of PCPs in Treating HCV Patients?:

Physician receptivity to emerging all-oral, interferon (IFN)-free therapies:

Although more than half of surveyed specialists feel comfortable with the idea of PCPs prescribing all-oral, IFN-free regimens to treatment-naive HCV patients with minimal liver damage, approximately one-third of surveyed PCPs expect to always refer these patients to a specialist for care.

Managed care organization (MCO) responsiveness to new HCV treatment guidelines: More than half of surveyed MCO pharmacy and/or medical directors (PDs/MDs) are aware of the American Association for the Study of Liver Diseases' treatment guidelines and the majority of them report that these guidelines have impacted their organization's willingness to reimburse or give favorable formulary status to HCV regimens recommended in these guidelines.

Use of formulary restrictions as a mechanism for cost control: Among the majority of PDs/MDs whose MCOs include Gilead's Sovaldi on formulary, these payers estimated that more than one-third of large commercial health plans and nearly half of Medicare Advantage plans restrict Sovaldi to prescription by specialists only, thereby preventing PCPs from utilizing this agent.

Comments from Decision Resources Group Analyst Hannah E. Cummings, Ph.D.:

"Most surveyed PCPs follow up with their specialist-referred patients with suspected or confirmed HCV infection and estimate that nearly one quarter of referred patients are lost in follow up. Similarly, most specialists report having PCP-referred patients who never appear for their exam; these physicians estimate 15 percent of PCP-referred patients do not follow up. Our findings suggest that referral to specialists represents a barrier to accessing care for some HCV patients. Therefore, direct HCV treatment by PCPs could help maximize the number of patients retained in care."

"The high price of Sovaldi is a major concern among payers, many of whom have spent tens of millions of dollars on this drug within the first quarter of 2014. Surveyed MCOs anticipate that even greater prescribing restrictions will be placed on emerging interferon-free therapies, which will represent a notable barrier to wider PCP involvement."

About Decision Resources Group

Decision Resources Group offers best-in-class, high-value information and insights on critical issues within the healthcare industry. Clients rely on this analysis and data to make informed decisions. Find out more at www.DecisionResourcesGroup.com.

7/10/14

Reference

HE Cummings. Primary Care Physicians in an Interferon-Free World: How Will the Availability of Safer and More Effective Oral Therapies Impact the Role of PCPs in Treating HCV Patients?June 2014

Other Source

Decision Resources Group. Nearly Three-Quarters of Surveyed Primary Care Physicians are Unfamiliar with Approved Direct Acting Antivirals for Hepatitis C Virus. Press release. June 19, 2014.