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December 25, 2014 by Legalized Pill P.U.S.H.A.

In January of this year I posted about a new Hepatitis C drug, SOVALDI™ manufactured by Gilead. Later in the year (October 2014) Gilead also released HARVONI™ which also treats (and according to Gilead cures Hepatitis C in the high 90 percentile).viekira Harvoni™ being a combination of ledipasvir/sofosbuvir. In other words it also contains the “Sovaldi™” component.

Just when we thought that Gilead had the Hepatitis C market all sewed up, a new product has been released, marketed by Abbvie called VIEKIRA PAK™. This product also boasts a high 90 percentile cure rate as well. All three products range from $27,000 – $31,000/month. Depending on which genotype a patient is diagnosed, therapy can be from 12 weeks to 26 weeks. All three can be taken with a Ribavirin product. Sovaldi™ and Harvoni™’s claim to fame is that they are “once” a day, one pill a day therapies. They contain no Interferon product which is most likely responsible for the flu-like symptoms, malaise, and fatigue associated with Hepatitis C therapy. The VieKira Pak™ is a 4 tablet daily dose pak with two (2) ombitasvir/paritaprevir/ritonavir tablets and two (2) dasabuvir tablets. Sovaldi™ is often times coupled with Olysio™ (which is an additional $23,000/month).

Like Sovaldi™ and Harvoni™, VieKira Pak™ also has a patient assistant program called proCeed which provides support for access to the drug, reduce financial barriers as well as track patient data (something which would be of interest to physicians and pharmacists). The great thing about is, VieKira Pak™ is, while only indicated for Genotype 1 (which happens to be the most common genotype in the United States) it contains a 4-drug combination for only one (1) price! Harvoni™ is also only indicated for genotype 1, but Sovaldi™ is indicated for genotypes 1, 2, and 3.

Being a pharmacist and this being the end of the year, we are bombarded with information regarding new changes in commercial, federal and state supported insurance plans. The pharmacy benefit managers (PBMs) are constantly updating their policies but most come at the end of the year, effective on January 1.

Now you are probably asking yourself, why did she go off on a tangent about PBMs? I did this because with the release of VieKira Pak™, ESI (Express Scripts) which happens to be a very large pharmacy benefit manager (probably one of the largest, if not the largest) just announced that they will exclude Harvoni™ and Sovaldi™ from their national preferred formulary, effective January 1, 2015. Now this doesn’t mean that you will not be able to get and/or prescribe Harvoni™ and Sovaldi™ for your patients . . . but it does mean you’ll probably have to submit and/or go through the prior authorization process (which we pharmacists lovingly call PA process) and you may (prescribers) have to prove that your patient failed on the “preferred” VieKira Pak™.

So prescribers and/or patients, if you are currently using and/or prescribing Sovaldi™ and/or Harvoni™, be aware that you may have to switch your patients to the VieKira Pak™. All three drugs report a high 90 percentile cure rate, all can have Ribavirin added to the therapy, but only one (VieKira Pak™) has a 4-drug combination for one price. Lastly, if ESI is moving to this as the “preferred” therapy for Hepatitis C, be on the lookout for CVS CAREMARK and Walgreens to follow in the near future.

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