HCV Quiz Flashcards
who determines WAC price?
pharma company
what is exclusivity in terms of hep med pricing?
restriction on what meds can be prescribed
how pharma company “sells” exclusivity
vouchers/WAC discounts
the liason between insurance company and pharma company
PBM (pharmacy benefit manager)
who determines formulary placement?
insurance company (can be diff for medicaid, private)
who determines OOP cost and med choice for pt?
insurance
in certain states, infected ppl might not be able to get tx dependent about
liver fibrosis stage
drug use
VA system usually gets discount/increased WAC price
discount
prison usually gets discount/increased WAC price
increased
specialty pharmacies might get paid for
early d/c rate
SVR rate
Pt assistance programs might be offered by
pharma companies, foundations
focus of cea is
health benfits
icer
incremental cost-effectiveness ratio
ICER threshold aka “societal willingness to pay”
avg return in QALY expcted if available budget used for current healthcare system as opposed to the new tx
typical length time horizon
1-5 y
why difficult to judge cost effectiveness of HCV drugs
lack of transparency in negotiations
t/f when making coverage decisions, insurance considers OOP for pt
false - only their own revenues and bottom lines
rivavirin - mechanism and SE
guanosine analog - inhibits viral RNA-dependent polymerase
SE: hemolytic anemia
pegylated interferon - mechanism and SE
1) binds to membrane receptpr - inhibits viral penetration, translation… release
2) ^HCA, phaocytic activity of macophage, killer T survival
SE: flu like sx
simprevir - mechanism and SE
NS3 - protease/helicase inhibitor
*use w/ or w/o riavirin
SE: rash, photosensitive, CYP interaction
sofobuvir - mechanism and SE
NS5B - RNA pol inhibitor
works against all genotypes
CI: renal dysfunction
ledapasvir - mechanism and SE
NS5A inhibitor - RNA replication assembly block
standard first line HCV tx
sofosbuvir (NS5B RNA pol i) + ledpipasivir/RBV/Peg
tx for kids >12yo and 77lb+
sofobusivir + ledapasvir
