on Medavie Blue Cross Plans
November 2016 - Despite major advances in chronic hepatitis C virus [HCV] treatments in recent years, the complexity, duration, tolerability and cost of treatment regimens have remained challenging.
With Health Canada’s recent approval of the first “pan-genotypic” drug EPCLUSA™, all HCV patient populations now have an effective treatment option with once-daily dosing and consistent 12 week treatment duration. This simpler treatment regimen is clinically effective, with limited requirement for combined ribavirin [RBV] use. With the cost per treatment of $60,000 across of all patient populations, EPCLUSA™ is significantly more cost effective than many alternatives including Harvoni® 12 or 24 weeks in HCV1 [$67,000 - $134,000 per treatment] and Sovaldi®-based combinations in multiple genotypes [$91,000 - $182,000 per treatment].
In light of this development, and related guidance from the Medication Advisory Panel (MAP) and HCV specialist, Medavie Blue Cross has revised coverage of hepatitis C treatments on its private health plans1.
Effective immediately, HCV treatment options eligible for reimbursement for new claimants on Medavie Blue Cross plans are limited to the following:
|HCV1||Epclusa™ 12 weeks +/-
Holkira Pak™ 12 weeks +/-
Zepatier™ 8-12 weeks +/- RBV
|HCV2||Epclusa™ 12 weeks +/- RBV|
|HCV3||Epclusa™ 12 weeks +/- RBV|
|HCV 4||Epclusa™ 12 weeks +/- RBV
Technivie™ 12 weeks + RBV
Zepatier™ 12 weeks
|HCV 5/6||Epclusa™ 12 weeks +/- RBV|
1Will be applied in Quebec in accordance with RAMQ requirements.
2Variation in treatment regimens for specific patient sub-populations, including viral load, treatment naive or experienced, cirrhotic, compensated or non-cirrhotic are detailed in the Special Authorization approval criteria.
This revised coverage enables appropriate patient access to a range of effective treatment options with improved tolerability and simplicity, and ensures lower costs for plan sponsors and members going forward. For eligible claimants outside of Quebec, approved HCV treatments will be dispensed through preferred pharmacies to provide additional cost savings and access to enhanced services for plan members.
REMINDER: Special Authorization requests for HCV treatments are considered for treatment of lab confirmed chronic HCV infection in adults with fibrosis stage F2 or greater. Patients must be under the care of a specialist experienced in treatment of HCV and have detectable HCV RNA level in most recent 6 months. A viral load report, fibrosis stage report and confirmation of presence or absence of cirrhosis is required with each request. All patients MUST be enrolled in the manufacturer’s patient support program [PSP] to be considered for coverage. Medavie Blue Cross is supplemental to government health care products and services and will not reimburse for any products or services eligible under government health care programs. At all times, coverage for Quebec participants will be adjusted to meet the minimum requirements of the prescription drug insurance act. Please direct any questions on this communication to [email protected].