Evaluation of Medication Therapy Issues, Resolutions, and Adherence Among Persons With HIV in the Pharmacist-Led Patient-Centered HIV Care Model.

OBJECTIVE: To identify medication therapy issues and resolutions and assess their relationship to antiretroviral therapy (ART) adherence among participants of the Patient-Centered HIV Care Model demonstration project. METHODS: Adult persons with HIV (PWH) in the United States were enrolled in the Patient-Centered HIV Care Model from August 2014 to September 2016. Pharmacists conducted regular medication therapy reviews and documented ART and non-ART issues and suggested resolutions. Adherence to ART was calculated using proportion of days covered (PDC), and the mean PDC by the number of ART issues was compared using a generalized linear model with linear trend estimation. RESULTS: The most common ART issue was adherence (57%). Adherence ART issues were resolved by adherence management (48%) or patient education (36%). Participants had a mean of 4.2 ART issues and 6.4 non-ART issues. PDC was 89% for those with 0 ART issues and 73% for those with ≥3 ART issues. Persons with 0 ART issues had an increase in adherence (+8%) in the postperiod, whereas those with ≥3 ART issues had a decrease in adherence (-6%) (P = 0.02) in the postperiod. CONCLUSIONS: Identifying therapy issues could help pharmacists improve care for PWH. Because PWH are an aging population with an increased risk of comorbidities and polypharmacy, pharmacists and providers should collaborate to provide holistic, primary care solutions to address both the number and nature of therapy issues.

Spending on Hepatitis C Antivirals in the United States, 2009-2015.

STUDY OBJECTIVE: New hepatitis C virus (HCV) antivirals have been shown to be highly effective with minimal adverse effects, but they are costly. Little is known, however, about the impact of the new HCV antivirals on expenditures in the overall U.S. health care system or by health care sector. Thus the objective of this study was to describe HCV antiviral expenditures by agent, year, and health care sector. DESIGN: Retrospective cross-sectional study. DATA SOURCE: QuintilesIMS National Sales Perspectives database. MEASUREMENTS AND MAIN RESULTS: QuintilesIMS National Sales Perspectives data for the period of January 1, 2009, to December 31, 2015, were used to describe HCV antiviral expenditures. HCV antiviral expenditures grew each year from $78 million in 2009 to $18 billion in 2015, except during 2013 when spending on HCV drugs dropped by $684 million (41%) compared with 2012. Although most expenditures in 2009 and 2010 were for interferons, this shifted to telaprevir in 2011-2013 and sofosbuvir-containing regimens in 2014-2015. Mail service and community pharmacies were associated with most of the expenditures throughout the study period. CONCLUSION: New HCV antivirals are driving the increased expenditures for this class. Decreased expenditures in 2013 may have been secondary to delaying HCV treatment until new therapies received approval from the U.S. Food and Drug Administration (termed "warehousing"). With continued drug development and approval of HCV therapies, expenditures are expected to continue to increase, barring actions by payers that may impede this trend. Medication policies guiding HCV treatment should focus on safety and efficacy while balancing the long-term costs of HCV.