Treating Hepatitis C:Comorbidity of the Wallet

Comorbidity of the Wallet

Posted by Dr. Stephen Vogt ⋅

April 16, 2012⋅

Filed Under BioPlus, Employer News, HCV, Health, Healthcare, Hepatitis, Liver, Pharmacy, Specialty Pharmacy

In just a few weeks, my son Josh will graduate from medical school and head off to the Mayo Clinic in Rochester to spend three years training in internal medicine. His final clinical rotation in medical school will be hepatology. I may be biased, but I believe he saved the best for last. Last night, during our regular weekly call, we discussed his patients. Six hepatitis C patients visited him in clinic earlier that day. He was surprised that the doctor did not want to treat their viral infection, but instead choose to keep the patients naïve and wait for “the new drugs.” I’ve been treating hepatitis C for 20 years and it seems like we are always waiting on “the new drugs.”

The current three drug regimen for hepatitis C brings about a 70 percent cure rate, however the side effects are horrible and the physician must contend with many drug-to-drug interactions. The doctor working with Josh explained that with these side effects, he simply can’t get his patients to complete the therapy.

I have heard this many times from other doctors and a variety of clinics. I’m here to say that the current therapy – although far from ideal – can be successfully completed by patients. In fact, we have an excellent completion rate in BioPlus patients being treated for hepatitis C. Consider our latest internal statistic for hepatitis C compliance, which includes all therapies, even the new triple therapies:

92.7% Compliance at Discharge(Data based on 60 non-compliant out of 817 hepatitis C patient discharges.)

I think the difference lies in the fact that we are specialists in this treatment. My team’s expertise helps patients navigate through the side effects and persevere with treatment. This is certainly not the case in hepatitis C patients supplied by a mail-order pharmacy.

“The New Drugs”
But what about “the new drugs” Josh’s doctor referred to? These are an interferon-free therapy that may soon be a welcome reality. Without interferon as part of the regimen, patients will face far fewer side effects. In addition, newer protease inhibitors and polymerase inhibitors have lower toxicity. In the future, the treatment should take less time and bring a higher response rate over the current regimens.

So why shouldn’t doctors have patients wait for this treatment in the future? Here’s what I explained to my son: by holding the patient you risk “comorbidity of the wallet.”
The comorbidity I am talking about can’t be found in any medical textbook or journal. It’s only found in the laboratory of life. The patient today has the resources to be treated. That is, they have insurance and companies such as mine can even offer co-pay assistance. But if the patient is held for “the new drugs” of the future, by the time those drugs actually arrive, the patient could lose their resources. Perhaps the patient loses his job or he has an unexpected change in health or personal situations that will not allow for treatment.

These are the risks inherent to the “comorbidity of the wallet” that can result in a patient who will not be able to be treated with “the new drugs.” I have heard this story many times: a patient shares with me that he had the resources to be treated last year, but now cannot afford it.

I’m not saying that the “comorbidity of the wallet” should be the sole driving factor in deciding if a patient should be treated or not, but it is a fact that is often forgotten in the treatment planning. Even so, at BioPlus we have a team of talented folks who deal with personal financial assistance of patients. They access co-pay assistance from the drug manufacturers, foundations, charities, and work within the patient’s resources. We will work our hardest to help patients overcome this comorbidity, if necessary.

Stephen C Vogt, PharmDPresident and CEO BioPlus SP

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