Primary care pharmacists at California VA treat HCV patients

Pharmacist-led model created to care for more HCV patients treated with DAAs

The word “cure” is rarely spoken in everyday health care settings, but primary care clinical pharmacist Elaine Lei, PharmD, considers herself fortunate to be able to say it consistently with patients. Lei has been part of a team at the VA Long Beach Healthcare System in California treating uncomplicated hepatitis C virus (HCV) cases using direct-acting antiviral agents (DAAs).

VA hospitals care for a large number of HCV patients, and more clinics throughout the country are now able to treat additional HCV patients using DAAs because of a recent national funding effort. Ledipasvir/sofosbuvir (Harvoni—Gilead Sciences) and elbasvir/grazoprevir (Zepatier—Merck & Co) are two of the most common DAAs prescribed for uncomplicated patients.

In the beginning, Macy Ho, PharmD, program director of the HCV clinic at VA Long Beach Healthcare System, wondered how they would treat more HCV patients while avoiding delays in initiating treatment, but she devised a plan using existing resources. Along with her liver pharmacist colleague, Ho began training primary care pharmacists in the VA’s Patient-Aligned Care Teams (PACT) to monitor patients with uncomplicated HCV.

The process starts with a PACT pharmacist identifying a potential HCV candidate when they visit the primary care clinic. Next, if the patient is interested in treatment, the PACT pharmacist will send the patient to the HCV clinic specialist to evaluate appropriate therapy.

Lei said patients often have to be educated and convinced that DAAs are effective therapy with minimal adverse effects. “Some patients are very hesitant due to bad side effects and low cure rates they heard about with the older agents, like interferon,” said Lei. DAAs in general seem to have a good safety profile, although clinical trials are still being conducted on many of these new agents.

Patients also won’t accept treatment if it’s too much of a hassle, according to Ho. The team’s job is to make it as efficient as possible. Once the HCV treatment is decided and initiated, patients without cirrhosis on monotherapy are referred back to their assigned PACT pharmacist for monitoring until the HCV treatment course is completed. The liver clinic usually retains the cirrhotic patients or patients on treatment with multiple agents. PACT pharmacists follow up with the uncomplicated HCV patients during treatment, where they are given a 1-month supply of medication at a time. The patients are followed until their HCV viral load is drawn 12 weeks after the end of treatment to make sure the patient has sustained viral response.

Ho said many health care systems could treat a larger number of HCV patients without hiring additional staff or acquiring extra clinical space, but just by utilizing trained pharmacists in the primary care clinic space.

For the full article, please visit for the February 2017 issue of Pharmacy Today.