title: Impact of specialty pharmacy on telaprevir-containing 3-drug hepatitis C regimen persistence.
abstract: BACKGROUND
  Although the recommended treatment of hepatitis C continues to evolve as newer and more effective medications are made available, hepatitis C drug regimens consisting of a 3-drug combination of a protease inhibitor, pegylated interferon, and ribavirin were recommended by the American Association for the Study of Liver Diseases for the HCV genotype I beginning in 2011. Although more effective than the earlier standard of care, these regimens have complex dosing schedules, prolonged duration, and deleterious side effects. It has been shown that patients tend to discontinue these regimens prematurely. Specialty pharmacies offer specialized care management programs to hepatitis C patients, consisting of such services as regularly scheduled patient counseling, assessing regimen appropriateness, monitoring treatment progress, scheduling refill reminders, and coordinating patient care with prescribers. The use of specialty pharmacies by hepatitis C patients may improve persistence on the 3-drug hepatitis C regimens.
  
  
  OBJECTIVE
  To examine the association of pharmacy dispensing channel (specialty pharmacy or retail pharmacy) and hepatitis C regimen persistence among patients on a 3-drug hepatitis C regimen containing telaprevir, a widely used hepatitis C protease inhibitor.
  
  
  METHODS
  A retrospective, observational study was conducted using pharmacy claims data from a national pharmacy benefits manager for the period July 2011 to June 2013. Continuously eligible patients who started a new 3-drug regimen containing telaprevir were included in the study and followed for up to 12 months after the index hepatitis C claim. The study outcome was persistence to the 3-drug regimen at treatment week 24 (day 168), representing the completion of an important milestone in the regimen. Patients were defined as persistent if they filled 84 days' supply of telaprevir and 168 days' supply of pegylated interferon and ribavirin each, as required by the regimen protocol. Multivariate logistic regression was used to evaluate the association between dispensing channel and persistence, controlling for differences in demographics, medication burden, out-of-pocket spend per 30-day adjusted hepatitis C prescription, and average days' supply per unadjusted hepatitis C prescription.
  
  
  RESULTS
  The final study sample consisted of 1,475 patients-1,182 in the specialty pharmacy group and 293 in the retail pharmacy group. A significantly greater proportion of patients were persistent to the 3-drug hepatitis C regimen containing telaprevir in specialty pharmacy, compared with retail pharmacy (56.0% vs. 39.9%, P  less than  0.001). After multivariate adjustment, patients in the specialty pharmacy group had 1.89 times greater odds of being persistent to 3-drug hepatitis C regimens containing telaprevir compared with patients in the retail group (95% CI=1.44-2.48).
  
  
  CONCLUSIONS
  Patients who used a specialty pharmacy offering refill reminders, care management, and care coordination with prescribers were significantly more likely to be persistent to 3-drug hepatitis C regimens, compared with patients using a retail pharmacy.
authors.affiliation: One Express Way, 2W05, St. Louis, MO 63134. SEFrazee@express-scripts.com.
authors.forename: Rochelle R
authors.initials: RR
authors.lastname: Henderson
authors.forename: Jay
authors.initials: J
authors.lastname: Visaria
authors.forename: Gail G
authors.initials: GG
authors.lastname: Bridges
authors.forename: Mary
authors.initials: M
authors.lastname: Dorholt
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Levin
authors.forename: Sharon Glave
authors.initials: SG
authors.lastname: Frazee
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000008:administration & dosage*; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010593:Pharmaceutical Services / Q000458:organization & administration; D010594:Pharmacies / Q000706:statistics & numerical data*; D011092:Polyethylene Glycols / Q000008:administration & dosage; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage; D014481:United States
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D009842:Oligopeptides; C571406:PEG-IFN-SA; D011092:Polyethylene Glycols; D012254:Ribavirin; C486464:telaprevir