Formulary Advantages Among Hepatitis C Virus Therapies: Pharmacy directors do not yet understand the pharmacoeconomic incentives to cover emerging therapies

Hepatitis C virus (HCV) is the leading cause of end-stage liver disease and hepatocellular carcinoma. Increasing diagnosis and treatment rates, and substantial unmet need combine to make HCV a high-growth opportunity over the next several years. Coverage of the two major brands of pegylated interferon-alfas (peg-IFN), Roche’s Pegasys (peginterferon-alfa-2a) and Merck’s PegIntron (peginterferon-alfa-2b), varies greatly between the private and Medicare channels. Three Rivers Pharmaceuticals’ Infergen (Interferon alfacon-1), a more recent market entrant with less favorable dosing, trails the peg-IFNs in coverage and tiering.

Because there is essentially only one choice for HCV drug treatment—combination therapy of IFN and ribavirin (Roche’s Copegus, Merck’s Rebetol, generics)—and there are limited options for treatment of non-responders, emerging agents that can offer improved efficacy will have a substantial market opportunity. Furthermore, the high current and historical failure rates for IFN/ribavirin combination therapy mean there is a large population of HCV patients awaiting new options that will likely take the first new therapy that is available and reimbursed. Vertex and Merck are racing to bring telaprevir and boceprevir, respectively, to market to try and capture this large population of HCV non-responders.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 51 pharmacy directors, this report determines the key trends in reimbursement of HCV treatments, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.