Hepatitis C virus (HCV) affects thousands of individuals in Mexico and Argentina. The launch of innovative therapies in recent years has brought new, highly effective options to the market, but reimbursement constraints tied to payers’ ability to fund these treatments sharply affect access to some of these medicines. Moreover, the type of payer—private versus public—requires companies operating in these markets to understand how the differences in economic capacity will affect their agent’s uptake. This A&R analysis provides key insights into navigating the HCV therapy market in Mexico and Argentina while adapting brand agents’ value message to payers’ and physicians’ needs and expectations in each country.

Scope:

Decision Resources Group’s Access and Reimbursement module for HCV in Argentina and Mexico explores the prescribing patterns for current therapies, the potential impact of the anticipated arrival of new agents, and key national and regional market access factors that will shape the use of HCV therapies over the next two to three years. This content draws on insights from 101 surveyed physicians and from interviews with six payers in Argentina and Mexico, all of whom have influence at the regional, institutional, or national level.

Markets covered: Argentina and Mexico

Primary research:

  • 100 hepatologists/gastroenterologists/infectious disease physicians
  • 6 payers:
    • Argentina:
      • Head of the liver transplantation department at a major hospital in Buenos Aires; member of the Argentine Association for the Study of Liver Diseases.​​​​​​
      • Hepatologist KOL at the Alexander Fleming Specialist Institute dedicated to SUR patients, a member of the Argentine Society of Gastroenterology, and a member of the American and European Associations of Diseases of the Liver.
      • Specialist in hepatology; consultant for the the MoH for the National Program for Control of Viral Hepatitis; member of the National Program for the Control of Immunopreventable Diseases (ProNaCEI); member of the Secretary and Board of the Argentine Association for the Study of Liver Diseases.​​​​​​
    • Mexico:
      • Head of the Medical Supplies Planning Department of the Infrastructure Branch of the ISSSTE’s Administration Directorate.
      • Chief of the gastroenterology, hepatology, and liver transplantation department at a major public hospital; member of the Mexican Association of Hepatology and the Mexican Association of Gastroenterology.
      • Coordinator of the clinical guidelines at CENETEC.​​​​​​​​​​​​

Questions answered in this report:

  • ​​​​​​​​​​​​​​What is the public and private healthcare coverage for targeted therapies for HCV by gentotype, and how do payers’ policies and infrastructure influence access to specialized healthcare and treatments?
  • What are the current drivers and barriers for prescribing established premium-priced agents such as Olysio, Daklinza, or Harvoni, and how does it compare with therapies that have been on the market for longer periods of time?
  • How does treatment vary by payer type and how can marketers of HCV therapies overcome hurdles in specific payer channels?
  • What clinical benefits are physicians and payers looking for in emerging therapies such as Epclusa and Zepatier, and what kind of savings in direct and indirect costs are payers seeking?

Table of contents

  • Hepatitis C Virus - Access & Reimbursement - Detailed, Expanded Analysis (Mexico & Argentina)
    • Key Updates
      • November 2017
      • September 2017
    • Market Access Overview
      • Actionable Recommendations to Optimize Market Access
        • Optimizing Market Access Opportunity for New HCV Therapies in Argentina and Mexico
      • Successes and Stumbles
        • Successes Among HCV Therapies in Argentina and Mexico
        • Stumbles Among HCV Therapies in Argentina and Mexico
        • Argentina: Coverage Successes & Stumbles of DAAs
          • Mexico: Coverage Successes & Stumbles of DAAs
          • Key Stakeholders in the Road to Market Access
            • Argentina
            • Mexico
          • Key Market Access Roadblocks
            • Key Market Access Roadblocks for HCV Therapies in Argentina and Mexico
            • Argentina: Key Market Access Roadblocks
            • Mexico: Key Market Access Roadblocks
          • Reimbursement Dynamics
            • Argentina: Coverage Dynamics for HCV
              • Argentina: HTA Process
              • Argentina: Drivers of Formulary Coverage for HCV Drugs
              • Argentina: Reimbursement/Coverage & HTA Details
              • Potential Changes for HTA in Argentina
              • Argentina: Key Background Details of the Healthcare System
            • Mexico: Coverage Dynamics for HCV
              • Mexico: HTA Process
              • Mexico: Drivers of Formulary Coverage for HCV Drugs
              • Mexico: Key Background Details of the Healthcare System
          • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
            • Prescriber Preferences for Genotype-1-Infected Patients
              • Most-Prescribed Treatment Regimen for Specific Genotype-1 Subpopulations
              • Most-Preferred Agents for Genotype 1
            • Prescriber Preferences for Genotype-2- and Genotype-3-Infected Patients
              • Most Prescribed Therapeutic Regimens for Genotype-2 Public Patients
              • Most-Preferred Agents for Genotypes 2/3
            • Impact of Payer Policy on Prescribing for Chronic HCV
              • Percentage of Patients Eligible for Treatment but Not Receiving Treatment Because of Budgetary/Reimbursement Reasons
              • HCV Patient Populations Facing the Most Treatment Barriers due to Cost and/or Coverage/Reimbursement Constraints
              • Top Coverage/Reimbursement and Cost Restrictions Limiting Prescribing to Eligible Chronic HCV Patients
            • Top Prescribing Drivers: Chronic Hepatitis C Virus
              • Top Prescribing Drivers for Treatment-Naive Noncirrhotic Patients
            • Key Levers and Constraints on Current Therapies
            • Market Access Landscape for Emerging Therapies
              • Likely Impact of Emerging Therapies for Chronic HCV
                • Physicians' Choice of Treatment for Genotype-1 Public Patients with Access Barriers
                • Physicians' Choice of Treatment for Genotype-1 Patients Without Access Barriers
              • Market Access Challenges for Emerging Therapies for Chronic HCV
                • Acceptable Launch Prices for Emerging Therapies: Epclusa
                • Acceptable Launch Prices for Emerging Therapies: Zepatier
                • Main Reasons for Not Prescribing Emerging Therapies in Argentina
              • Payer Opinion on Emerging Therapies for Chronic HCV
                • Argentina: Payer Opinion on Emerging Therapies for Chronic HCV
                • Mexico: Payer Opinion on Emerging Therapies for Chronic HCV
            • Methodology
              • Abbreviations
              • Primary Research Design
              • Background of Payers and Payer-Advising KOLs
              • Physician Demographics and Practice Setting
                • Country Practice Location
                • Physician Specialties
                • Years in Practice Postresidency
                • Chronic HCV Patients Treated/Monitored in the Last Six Months
                • Stages of Liver Damage at the Start of Therapy for Chronic HCV
                • Awareness of Current and Emerging Therapies for Chronic HCV
                • Percentage of Chronic HCV Patients with Different Genotypes Currently Treated/Treated in the Past Six Months with Pharmacotherapy
                • Practice Setting
                • Percentage of Public and Private Patients Receiving Treatment
                • Mexico: Location of Practice
                • Argentina: Location of Practice
                • Type of Hospital Where Respondents Practice
                • Mexico: Affiliation of Public Patients Receiving Treatment
                • Prescribing of Chronic HCV Therapies Within the Past Six Months
              • Pricing Methodology
            • Appendix
              • Commercial Context
                • Total Prevalence of HCV in Argentina and Mexico
                • Argentina: Treatment Guidelines for HCV
                • Mexico: Treatment Guidelines for HCV
                • Profiles of Key Drugs for Chronic HCV
                • Advantages and Disadvantages of Key Drugs for Chronic HCV
                • Daily Cost of Select Chronic HCV Drugs
                • Timeline of Approvals of Key Current and Emerging Therapies
                • Emerging Therapy: Epclusa (Sofosbuvir/Velpatasvir)
                • Gilead's Epclusa (Sofosbuvir/Velpatasvir)
                • Emerging Therapy: Zepatier (Grazoprevir/Elbasvir)
                • Merck's Zepatier (Grazoprevir/Elbasvir)
              • Physician Survey Data
                • Argentina: Formulary Inclusion of Drugs for Chronic HCV
                • Argentina: Formulary Inclusion of Drugs for Chronic HCV (cont.)
                • Mexico: Formulary Inclusion of Drugs for Chronic HCV
                • Mexico: Formulary Inclusion of Drugs for Chronic HCV (cont.)
                • Argentina: Chronic HCV Patients Not Receiving Treatment Because of Budgetary/Reimbursement Issues
                • Mexico: Chronic HCV Patients Not Receiving Treatment Because of Budgetary/Reimbursement Issues
                • Treatment Barriers and Priorities of Different Chronic HCV Patient Populations
                • Argentina: Coverage/Reimbursement and Cost Restrictions Limiting Prescribing for Treatment-Eligible Chronic HCV Patients
                • Mexico: Coverage/Reimbursement and Cost Restrictions Limiting Prescribing for Treatment-Eligible Chronic HCV Patients
                • Argentina: Common Access Routes to HCV Therapies When Unavailable or Not Covered
                • Mexico: Common Access Routes to HCV Therapies When Unavailable or Not Covered
                • Changes in Prescribing for HCV in the Past Year
                • Argentina: Changes in Prescribing for HCV in the Past Year
                • Mexico: Changes in Prescribing for HCV in the Past Year
                • Argentina: Impact of New Guidelines on the Prescribing of New Agents
                • Mexico: Percentage of Chronic Hepatitis C Patients Who Are Warehoused
                • Argentina: Stage of Liver Disease Among Genotype-1, -2, and -3 Public Patients
                • Mexico: Stage of Liver Disease Among Genotype-1, -2, and -3 Public Patients
                • Argentina: Stage of Liver Disease Among Genotype-1, -2, and -3 Private Patients
                • Mexico: Stage of Liver Disease Among Genotype-1, -2, and -3 Private Patients
                • Argentina: Percentages of Patients Who Are DAA-Experienced, Renally Impaired, and/or HIV/HCV Co-Infected
                • Mexico: Percentages of Patients Who Are DAA-Experienced, Renally Impaired, and/or HIV/HCV Co-Infected
                • Duration of Selected Treatments
                • Argentina: Percentage of Patients Receiving Sovaldi vs. Probirase
                • Argentina: Reasons for Prescribing Probirase Instead of Sovaldi
                • Preferred Version of Sofosbuvir: Sovaldi vs. Probirase
                • Argentina: HCV Therapies’ Share of Treatment-Naive Noncirrhotic Patients
                • Mexico: HCV Therapies’ Share of Treatment-Naive Noncirrhotic Patients
                • HCV Therapies’ Share of Treatment-Naive Noncirrhotic Patients
                • Argentina: HCV Therapies’ Share of Treatment-Naive Cirrhotic Patients
                • Mexico: HCV Therapies’ Share of Treatment-Naive Cirrhotic Patients
                • HCV Therapies’ Share of Treatment-Naive Cirrhotic Patients
                • Argentina: HCV Therapies’ Share of Treatment-Experienced Noncirrhotic Patients
                • Mexico: HCV Therapies’ Share of Treatment-Experienced Noncirrhotic Patients
                • HCV Therapies’ Share of Treatment-Experienced Noncirrhotic Patients
                • Argentina: HCV Therapies’ Share of Treatment-Experienced Cirrhotic Patients
                • Mexico: HCV Therapies’ Share of Treatment-Experienced Cirrhotic Patients
                • HCV Therapies’ Share of Treatment-Experienced Cirrhotic Patients
                • Argentina: Percentages of Patients Receiving Incivo vs. Victrelis
                • Argentina: Most Prescribed Therapeutic Regimens for Genotype-2 Patients
                • Mexico: Most Prescribed Therapeutic Regimens for Genotype-2 Patients
                • Argentina: Most Prescribed Therapeutic Regimens for Genotype-3 Patients
                • Mexico: Most Prescribed Therapeutic Regimens for Genotype-3 Patients
                • Argentina: Prescribing Drivers of Current Therapies for Genotype-1 Patients
                • Mexico: Prescribing Drivers of Current Therapies for Genotype-1 Patients
                • Argentina: Prescribing Drivers of Specific Current Therapies for Genotype-1 HCV
                • Mexico: Prescribing Drivers of Specific Current Therapies for Genotype-1 HCV
                • Argentina: Prescribing Drivers of Current Therapies for Genotype-2/3 Patients
                • Mexico: Prescribing Drivers of Current Therapies for Genotype-2/3 Patients
                • Argentina: Prescribing Drivers of Specific Current Therapies for Genotype-2/3 HCV
                • Mexico: Prescribing Drivers of Specific Current Therapies for Genotype-2/3 HCV
                • Most Frequently Prescribed Treatment Regimen for Specific Genotype-1 Subpopulations
                • Most Frequently Prescribed Treatment Regimen for Specific Genotype 2/3 Subpopulations
                • Physicians' Choice of Treatments for Genotype 1 in the Absence of Access Barriers
                • Argentina: Physicians' Choice of Treatments for Genotype 1 in the Absence of Access Barriers
                • Mexico: Physicians' Choice of Treatments for Genotype 1 in the Absence of Access Barriers
                • Physicians' Choice of Treatments for Genotypes 2/3 in the Absence of Access Barriers
                • Argentina: Physicians' Choice of Treatments for Genotypes 2/3 in the Absence of Access Barriers
                • Mexico: Physicians' Choice of Treatments for Genotypes 2/3 in the Absence of Access Barriers
                • Unmet Needs in the Treatment of Chronic HCV
                • Expected Prescribing of Emerging Therapies
                • Argentina: Prescribing Drivers of Emerging Therapies
                • Mexico: Prescribing Drivers of Emerging Therapies
                • Argentina: Reasons for Not Prescribing Emerging Therapies
                • Mexico: Reasons for Not Prescribing Emerging Therapies
                • Acceptable Launch Prices for Emerging Therapies: Epclusa
                • Acceptable Launch Prices for Emerging Therapies: Zepatier
                • Physicians' Recommendation for Coverage of Emerging Therapies for Chronic Hepatitis C
                • Impact of the Availability of Emerging Therapies on Current Prescribing for Genotype-1 Treatment-Naive Noncirrhotic Patients
                • Impact of the Availability of Emerging Therapies on Current Prescribing for Genotype-1 Treatment-Naive Cirrhotic Patients
                • Impact of the Availability of Emerging Therapies on Current Prescribing for Genotype-1 Treatment-Experienced Noncirrhotic Patients
                • Impact of the Availability of Emerging Therapies on Current Prescribing for Genotype-1 Treatment-Experienced Cirrhotic Patients
                • Argentina: Expected Choices of Treatments for Genotype-1 Public Patients
                • Mexico: Expected Choices of Treatments for Genotype-1 Public Patients
                • Expected Choices of Treatments for Genotype-1 Public Patients
                • Argentina: Expected Choices of Treatments for Genotype-1 Private Patients
                • Expected Choices of Treatments for Genotype-1 Private Patients
                • Mexico: Expected Choices of Treatments for Genotype-1 Private Patients
                • Argentina: Expected Choices of Treatments for Genotype-2/3 Public Patients
                • Expected Choices of Treatments for Genotype-2/3 Public Patients
                • Mexico: Expected Choices of Treatments for Genotype-2/3 Public Patients
                • Argentina: Expected Choices of Treatments for Genotype-2/3 Private Patients
                • Expected Choices of Treatments for Genotype-2/3 Private Patients
                • Mexico: Expected Choices of Treatments for Genotype-2/3 Private Patients
                • Physicians' Choice of Treatments for Genotype-1 Patients Without Access Barriers
                • Argentina: Physicians' Choice of Treatments for Genotype-1 Patients Without Access Barriers
                • Mexico: Physicians' Choice of Treatments for Genotype-1 Patients Without Access Barriers
                • Physicians' Choice of Treatments for Genotype-2/3 Patients Without Access Barriers
                • Argentina: Physicians' Choice of Treatments for Genotype-2/3 Patients Without Access Barriers
                • Mexico: Physicians' Choice of Treatments for Genotype-2/3 Patients Without Access Barriers
              • About Decision Resources Group
                • Susana Silva

          Author(s): Susana Ribeiro da Silva; Roy Moore, MBA

          Roy manages global market access content for DRG, including US Access & Reimbursement (legacy PPF) and the Global Market Access Solution.

          He has 10 years of experience writing/managing in market access content, including nearly two years on the global front. For nearly five years, he has managed/directed what had been U.S. Physician & Payer Forum. Previously, he spent five years as an analyst for legacy HealthLeader-InterStudy’s health plan analysis team, focusing on Florida, Illinois, and the national Medicare market. He also had 5 years business reporting experience with a focus on healthcare.