1. Establishing a Pharmacy Managed HCV Service
LCDR Jessica L. Steinert, PharmD, MHA, BCGP
LT Neelam Gazarian, PharmD

2. Prior to HCV Clinic With Insurance (Pvt./Federal) Without Insurance
Referred to Medical Specialists
$10,000-$15000/referral
Distance
Lost to follow-up
Without Insurance
Very Few Options
Rationing Care
Poor outcomes
Lost to follow up/less documentation
No tracking of patients

3. Inter-collaborative Approach
Patient
Primary Care Provider
Pharmacist
Laboratory Services
Benefits Coordinator
Behavioral Health
Public Health
Patient centered interprofessional collaboration to Policy making
Education and awareness

4. Identifying Patients with Hepatitis C
iCare
168 patients
25% screening rate
VGEN
155 patients
Getting a sense of how many patients with diagnosis of hcv. Jessica and David huge help
Patients with visit in past year
Screening rate with a denominator of patients born between 1945 and 1965 (baby boomers)
From reports from vay, based on old labs. Often patients deceased, moved away

5. EHR Documentation Referral Initial Visit Treatment End of Treatment
Consult from PCP
Walk in
Initial Visit
PHQ-9
AUDIT-C
Education
Labs
Immunizations
Comprehensive
visit
Project ECHO
Start Medication Authorization
Treatment
Counseling
End of Treatment
SVR
Patient is cured!
Counsel about re-infection and prevention
Comprehensive visit usually done on the phone.

6. Consult Template

7. EHR Note Templates

8. Hepatitis C Labs Order Menu

9. Hepatitis C Labs Order Set

10. Managing Patients
Snapshot of stage in treatment process drop down menus (these can be adjusted)
Reminders for labs while in treatment, immunizations

11. Patient Panel

12. Individual Patient Data

13. Appointment Calendar
Reminders for labs while in treatment, immunizations

14. Navigating Insurance/Prior Authorizations
Comprehensive Visit Clinic Notes
Project ECHO
Recommended regimen
Lab Values
Chem 14, CBC, anemia panel, Vit D, AFT, HIV, Hep A & B, pregnancy
Viral load and genotype
Fibrosis Score: APRI, FIB4, Fibrotest
Abstinence requirements
Urine drug screens and/or clinical notes
Compliance
Differs by state

15. Patient Assistance Program
Gilead’s Support Path
Harvoni®, Epclusa®
iAssist:
AbbVie Patient Assistance Foundation
Mavyret®
Type 1: Epclusa ( sofosbuvir/velpatasvir, with ribavirin in cases of decompensated cirrhosis) , Harvoni (ledipasvir/sofosbuvir), viekira pak, zepatier
Type 2: Epclusa, sovaldi (sofosbuvir) with ribavirin
Type 3: Epclusa only given with ribavirin in cases of decompensated cirrhosis
Type 4: Epclusa, Harvoni, zepatier
Type 5: Epclusa, Harvoni
Type 6: Epclusa, Harvoni
Mavyret (glecaprevir/pibrentasvir): 1, 2, 3, 4, 5, 6
Mavyret still not on abbvie patient assistance program list, soon hopefully?
ND Medicaid just added as preferred non-formulary

16. Patient Assistance Programs
Tribal ID card
Income documents
Max income allowed differs by program
Proof of no insurance
American Indians/Alaska Natives (AI/AN): Indian Health Coverage Exemption
“American Indians and Alaska Natives (AI/ANs) and other people eligible for services through the Indian Health Service, tribal programs, or urban Indian programs (like the spouse or child of an eligible Indian) don't have to pay the fee for not having health coverage. This is called having an Indian health coverage exemption.”

17. Time Investment and Workload (Minutes)30
Initial Visit
ECHO
Prior Authorization 60
Treatment
Counseling
Almost 3 hours per patient

18. 37 28 44 49 Current Status 24 22 2 4 9 7 5 22 Pending Project Echo ETR
Medication Approval Pending 4
Treatment 9
ETR 7
SVR “cure” 5
Appointment with PCP, more labs pending (possible self clearers)
ETR: end of treatment response 3 months 22 24 28 37 44 49

19. HCV Screening Rate

20. HCV Screening Rate

21. Cost Analysis: Cumulative
$1,831,608
Flat rate reimbursement from ND Medicaid and expansion to IHS, outsource for cost avoidance

22. Questions

23. Thank you
Contact Info: