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Targeted videos support improved patient adherence

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Posted January 19th, 2016

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Professionals looking over programs

Despite vast improvements in treatment effectiveness and simplicity, treating hepatitis C (HCV) is still far from routine. High medication adherence is important for any treatment, but has proven particularly problematic in treating HCV, with earlier treatments plagued by adherence rates as low as 40-50%.1 According to presenters at the recent annual meeting of the National Association of Specialty Pharmacy (NASP), HCV treatment adherence remains a significant challenge—and one that can jeopardize patients’ chances of a sustained cure.2

The most modern HCV treatments are much simpler to take than before. Ordinarily that is good for adherence, however doctors are finding that patients can become complacent and fail to stick to the treatments as they should. This is worrisome, because missing doses for as little as 24 to 48 hours can inhibit response to the newer regimens.2 Patients who abandon therapy have also been a problem in the past for HCV treatment. Yet even quite recently, a major PBM discovered that their HCV patients were becoming non-adherent at a very high rate, even using the latest drugs.3

The case of Harvoni® (ledipasvir and sofosbuvir), is particularly interesting. Harvoni plays a key role in the OptumRx approach to managing HCV treatment. Nationwide, it accounted for about three-fourths of all prescriptions filled for HCV drugs in the first quarter of 2015.4 And Harvoni is not inexpensive, with retail (undiscounted) costs of approximately $98,000 for a standard 12-week treatment.4

With this context, we set out to learn whether Harvoni patients could benefit adherence-wise from a new approach to supporting people with complex conditions like HCV. This system is called BriovaCommunity.™

Background

Harvoni is one of the newest antiviral medications used to treat HCV.5 Since its introduction, Harvoni has won wide acceptance for its high levels of effectiveness in curing HCV.6 Part of its effectiveness stems from the fact that, compared with earlier treatments, it is simple to take: A once-per-day pill that needs a relatively short treatment duration and that has minimal side-effects.6 In fact, in clinical trials, Harvoni showed overall medication adherence rates that ranged from 96% to nearly 100%.7

Adherence can be defined a number of ways, but it basically means that a patient is taking their medicine how and for as long their doctor has directed. As noted, previous HCV treatments suffered from low adherence rates. They were difficult to administer, requiring self-injections plus multiple other drugs used in combination, each with its own set of challenges relative to dosing and tolerability. Therapy could last many months, often producing debilitating side-effects. Worse, in many cases these drug combinations frequently failed to affect a cure.1 For these and other reasons, keeping patients faithful to their HCV therapy has been a chronic problem, leading to widespread wasted medication, high cost and increased drug resistance by the virus.8

Therefore, the extremely high adherence rates observed for Harvoni during clinical trials were especially welcomed news. However, it is understood that participating in a clinical trial is not the same as taking a drug in real life. It is common to see lower adherence rates amongst patients who are not part of a trial, or once they leave the trial.9

In the past, HCV treatments have been particularly susceptible to steep fall-offs in medication adherence once drugs moved from trials to actual clinical settings.10 This was expected to improve thanks to improved new-generation medications. But just last year, one PBM found that patients were abandoning their treatment with one of the very newest HCV drugs at a rate four times greater than that observed within its clinical trials.3 These abandoned treatments, combined with the increased complacency toward treatment reported above, may indicate potential cause for concern regarding HCV treatment adherence.

A new approach to patient support

In light of the potential pitfalls that threaten proper medication adherence for HCV treatment, we recently initiated a new patient adherence support program called BriovaCommunity. BriovaCommunity comes from BriovaRx®, the new name for the OptumRx specialty pharmacy.

BriovaCommunity is a program where patients are sent tailored videos, based on their condition and treatment regimen, direct to their inbox (including computer, tablet or smart phone). Patients receive these emails throughout the course of their treatment to provide continued encouragement and answer common questions a patient might have while taking the medication.

The videos are designed to help guide patients on the right path during their treatment. Videos contain testimonials from patients, plus recommendations and advice from experts in the field. They are sent videos throughout treatment to continue to encourage the patient to stay adherent, and to answer questions they might have while taking the medications. The videos also introduce patients to BriovaRx pharmacists, who provide insights and help tips about properly taking their medications.

Study results

Adherence is the percentage of doses taken as prescribed, over a set time period for analysis (either from the first to last medication dispensing date or for a fixed follow-up time frame).11 Persistence is defined as the total number of days taking medication over a set time period.11

This study compared patient adherence but also the combination of adherence plus persistence, based on patients who had their first prescription fill of Harvoni between January 1, 2015 and March 31, 2015. Results for these three groups are shown in the graphs below:

  • Briova Community Harvoni users
  • Briova Community Harvoni users versus other specialty program Harvoni users
  • Briova Community Harvoni users versus retail pharmacy Harvoni users

Bar graph showing Briova Community had higher persistency to Harvoni than all other channels

Overall, the study showed that patients taking Harvoni in a real-life setting achieved adherence rates similar to those shown in clinical trials, which ranged from 96% to nearly 100%.7 In general, patients taking Harvoni were significantly more likely to stay compliant with their prescribed regimens if they were receiving support from the BriovaCommunity program.

Bar graph adherence to Harvoni than all other channels

Discussion

Today, patients with chronic conditions feel increasingly engaged and empowered to be partners in their care.12 People with complex medical conditions frequently use online health resources in order to educate themselves. For example, Google reports that one of every 20 searches they host is looking for health-related information.13

In particular, HCV patient advocacy groups urge patients who are considering undergoing therapy to be proactive in order to promote successful outcomes.14 Being proactive can include information-seeking but also joining patient support groups, which are also considered to be crucial resources for HCV patients.14

Patients who use self-directed online health support systems can benefit, in a general sense, from additional information and even emotional support from other people in a similar situation.12 Still, not everything about this patient-driven health information model is ideal. Information found on the internet can be unreliable, whether in quality or in how it applies to an individual situation.13

For example, patients can be falsely reassured by online sources of information.12 And the sheer amount of information available can leave online participants feeling overwhelmed and frustrated with conflicting points of view.13

The idea behind BriovaCommunity is to provide patients with a support system that takes the information-seeking burden off of the patient. Instead, the automated system pushes timely, authoritative, high-quality information tailored exactly to each patient’s needs in order to maintain high medication adherence and other healthy lifestyles.

Then there is the “community” aspect of BriovaCommunity. Studies have shown the value of a support group of patients who have been on similar therapy.14 Patients who participate in the BriovaCommunity program will see and hear video from a community of individuals with similar conditions. Hearing their stories can help with emotional issues and with strategies for managing side effects while on treatment.14

Additionally, caregivers can use BriovaCommunity to learn how to better provide support in managing these complex conditions. Through the BriovaCommunity app, patients and caregivers can view videos on smartphones, tablets and other devices—anytime, anywhere.

Conclusion

BriovaCommunity is just one of the innovative engagement tools from BriovaRx. And as the costs and prevalence of specialty medications continue to grow, we are working to develop not just programs and tools, but also to make sure that the methods we use to engage our patients are evolving in step with their needs and preferences.

While retail-counter conversations or mass mailings might have served in the past, today we’re leveraging the technologies our patients are using. This allows them more control over how and when they receive information, which in turn fosters greater ownership and engagement.

Contact your representative to learn more about how we proactively engage patients to help them better understand their conditions and specialty medications. You will see how, together, BriovaRx and OptumRx are delivering on our goal to provide high-quality, integrated pharmacy services that promote optimal member outcomes, superior savings and outstanding customer service.

References
  1. Hepatitis Central. What is the Conventional Medical Treatment for Hepatitis C? Accessed at: http://www.hepatitiscentral.com/hepatitis-c/hepatitis-c-conventional-treatment/?ssrc=left_sidebar on 12.03.2015.
  2. Specialty Pharmacy Continuum. Hepatitis C: Don’t Squander the Cure. Dec. 22, 2015. Accessed at: http://www.specialtypharmacycontinuum.com/Clinical/Article/12-15/Hepatitis-C-Don-t-Squander-the-Cure/34336 on 01.06.2016.
  3. CVS Health. Analysis of “Real World” Sovaldi® (sofosbuvir) Use and Discontinuation Rates. Sept. 2014. Accessed at: https://www.cvshealth.com/sites/default/files/styles/SovaldiUseAndDiscontinuation_ResearchArticle_PDF.pdf on 12.03.2015.
  4. Modern Healthcare. Pricey successor overtakes $1,000-per-pill Sovaldi. July 13, 2015. Accessed at: http://www.modernhealthcare.com/article/20150713/NEWS/307139980 on 12.14.2015.
  5. Drugs.com. Harvoni. April 8, 2015. Accessed at: http://www.drugs.com/harvoni.html on 12.03.2015.
  6. Hepatitis Central. Harvoni Is Here: The Once-a-Day, Single Hep C Pill. Nov. 12, 2014. Accessed at: http://www.hepatitiscentral.com/news/harvoni-is-here-the-once-a-day-single-hep-c-pill/ on 12.03.2015.
  7. HIV and Hepatitus.com CROI 2015: Good Sofosbuvir/Ledipasvir Adherence in SYNERGY and ERADICATE Trials. April 10, 2015
  8. NAM Aidsmap. Adherence to hepatitis C treatment: unravelling the complexities. Dec 13, 2012. Accessed at: http://www.aidsmap.com/Adherence-to-hepatitis-C-treatment-unravelling-the-complexities/page/2557193/ on 12.03.2015.
  9. Hypertension. 2011; 58: 573-578. Participation in a Clinical Trial Enhances Adherence and Persistence to Treatment: A Retrospective Cohort Study. August 8, 2011, doi: 10.1161. Accessed at: http://hyper.ahajournals.org/content/58/4/573.full on 12.03.2015.
  10. Patient Preference and Adherence. Patient adherence issues in the treatment of hepatitis C. May 23, 2014; 8: 763–773. doi: 10.2147/PPA.S30339. Accessed at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4043798/ on 12.14.2015.
  11. Narrative Review of the Literature on Adherence to Disease-Modifying Therapies Among Patients with Multiple Sclerosis. January/February 2013 Vol. 19, No. 1-a. Accessed at: http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=16102 on 11.19.2015.
  12. Journal of Medical Internet Research 2015;17(6):e155. eHealth, Participatory Medicine, and Ethical Care: A Focus Group Study of Patients’ and Health Care Providers’ Use of Health-Related Internet Information. June 22, 2015. DOI: 10.2196/jmir.3792. Accessed at: http://www.jmir.org/2015/6/e155/
  13. Medical Economics. Dealing with Dr. Google: Why communication is key. April 17, 2015. Accessed at: http://medicaleconomics.modernmedicine.com/medical-economics/news/dealing-dr-google-why-communication-key?page=0,0 on 11.18.2015.
  14. HCSP FACT SHEET. Adherence to HCV Therapy. VERSION 6, July 2015. Accessed at: http://hcvadvocate.org/hepatitis/factsheets_pdf/Adherence.pdf on 12.03.2015.