Walgreens Local Specialty Pharmacy - Hepatitis C Medication Access

1. What You Need to Know -Medication Access Sarah Spencer, PharmDAugust 1, 2018

2. Our passion is personal Connecting with you and your hepatitis C patients, so they can finally connect to a cure

3. Walgreens Local Specialty Pharmacy • Closer to you and your patients • Beyond retail pharmacy services, Walgreens has specialty locations across the nation to better serve you, your patients and the community • Caring for complex patients • Maintaining a comprehensive patient profile • Managing administrative burdens • Helping with medication costs • Free overnight delivery to patient or depot to Walgreens or Rite Aid • Adherence counseling & refill reminder calls

4. Two Kentucky Locations • Walgreens Local Specialty 532 S. 4th St. Louisville, KY 40202 Phone: (502) 434-3122 Fax: (502) 434-3123 • Community Walgreens 393 Waller Ave Suite 5 Lexington, KY 40504 Phone: (859) 551-4447 Fax: (859) 551-4448

5. Access We do everything we can to get your patients the medications you prescribe • In our pharmacies • Trained pharmacy staff • Billing specialists • In the community • Strong relationships with drug manufacturers • Connecting patients to copay cards and patient assistance programs • Some plans may have copays as high as $3,000 and we can obtain a grant bringing the patients cost down to $0!

6. Hepatitis C Specialized Pharmacists • Our pharmacists know what it takes to get your patients through therapy • Balancing therapies • Providing answers to questions • Keeping you up to date • Helping with the day-to-day • Managing comorbidities • Navigating the insurance process

7. Experience • Treatment of over 130 Hepatitis C patients in the last 2 years, increasing rapidly • All eligible patients have received treatment • 100% of patients received full course of treatment • Follow patient/provider to SVR • One confirmed treatment failure – able to recommend another treatment and obtain approval quickly • Increased retention in care

8. Overcoming the Challenges of Medication Access: Insurance Formularies • Selecting plan preferred treatment may save time and expedite time to treat • Glecaprevir/ pibrentasvir (G/P) preferred on all KY-managed Medicaid plans • Ledipasvir/sofosbuvir (LDV/SOF) and sofosbuvir/velpatasvir (SOF/VEL) preferred on most Humana and CVS Caremark plans • Many Express Scripts plans are now switching from LDV/SOF and SOF/VEL to G/P • If the plan preferred medication is not best for the patient, give detailed explanation of why in PA and the risks of not using the appropriate therapy for the patient

9. Overcoming the Challenges of Medication Access • Proof of Chronic HCV: 2 HCV RNA’s 6 months apart • Chart documentation required by many insurance plans: • Date of diagnosis • Current and possibly previous labs • Pharmacy will provide reminder for 2nd HCV RNA lab in 6 months if needed for new diagnosis • Timing is Everything! Some Plans Require: • HCV RNA within the last 90 days • CMP and CBC from last 30 days • Pharmacy will proactively recommend new labs before submitting PA if labs are outdated- We want your treatment approved! • Reminders from pharmacy

10. Overcoming the Challenges of Medication Access • Most of the KY Medicaid plans require documentation of treatment plan – this is not on the PA form • Include in chart notes or submit addendum with PA • Patient is ready for treatment • Documentation of prescriber counseling regarding the risk of alcohol or IV drug abuse • Patient does not have a short life expectancy < 12 months • Provider agreement to submit HCV-RNA labs if required • Bottom Line: Call the pharmacy or send the RX, and let us update you with the specific plan requirements and next steps!

11. KY Plan Requirements

12. KY Medicaid Plan Criteria & PA Forms

13. Local Specialty Intake Form

14. Adherence • Multiple touchpoints in patient management program • Financial assistance • Obtain complete medication history preventing drug interactions • Counsel on OTC’s, herbals and avoiding alcohol and illicit drugs • Counseling on administration and side effects • Initiation and refill reminder calls to the patient

15. Adherence • Updates to the provider on a regular basis • Fax update monthly to provider with delivery date • Side effect or adherence fax/call to provider if an issue is identified while on therapy • Confirmation that patient completes full course of treatment • Follow up with provider to obtain SVR

16. Local specialty pharmacy & specialty clinic collaboration assists access to hepatitis C direct-acting antivirals • Retrospective study in Atlanta with a single clinic and single Walgreens Local Specialty Pharmacy • 94% of patients achieved SVR in a difficult to treat populations • Majority of patients had advanced liver disease • Medium time to therapy was 4 days compared to 23 days in literature • After pharmacy intervention 98.1% of patients had a copay <$20 Zhu J, Hazen RJ, Joyce C, Delpino A, Kirkham HS, Strickland CD, Markes-Wilson S, Kim T, Kang M, Rubin RA, Stein LL.Local specialty pharmacy ad specialty clinic collaboration assists access to hepatitis C direct-acting antivirals. J Am Pharm Assoc (2003). 2018 Jan-Feb;58(1):89-93.e2.doi: 10.1016/j.japh.2017.10.011. Epub 2017 Nov 16

17. Resources • Positively Aware Magazine with Hepatitis B & C medication guide • Links to Medicaid criteria and forms in binder • Chart with plan specific criteria in binder • Walgreens intake form in binder • Sarah.m.spencer@Walgreens.com • Walgreens Local Specialty Louisville • Phone: (502) 434-3122 • Fax: (502) 434-3123