In an interview with at AMCP Nexus 2023, Jeff J, Mclntyre, MA, Vice President of Liver Health Programs, Global Liver Institute, discussed the clinical and economic burden of NASH and how pharmacists can facilitate access to care for patients with the disease. Can you give a brief overview of NASH, specifically the clinical and economic burden for patients? Image credit: Rasi | NASH is the end stage, disease state for fatty liver disease. It’s when there’s been enough fat that has developed over the liver or on the liver, that it’s become fibrotic and eventually, cerotic. This is a progressive devastating disease for most individuals, as the outcomes— if not treated leads to the need for transplant, there is possibility of liver cancer and then ultimately, there’s also a possibility of death. How can pharmacists facilitate access to care and be involved in the patient’s journey of the disease? I think the main thing for pharmacists to be aware of is that when you see these markers for early stage, NASH, as I said, that are often confused with other symptoms. We know if you have diabetes, you’ve likely had fatty liver disease. But often the diabetes is what is emphasized, and fatty liver is kind of left alone until it’s advanced, until a more significant or more critical state. Pharmacists are really important in terms of looking at what sort of range of medications a patient may be able to be on, and having the conversation with them about whether they need to be screened, or whether there needs to be some sort of diagnostic effort for liver disease while they’re also combating some sort of diabetes or cardio metabolic disease as well. What are some ways pharmacists can address challenges and optimize appropriate treatment for patients, while giving consideration to the economic burden for some? We know one of the main populations for any sort of non-communicable disease is that this is a poor person’s disease. For folks that are able to pay out of pocket for things like weight loss medication or expensive medications that may help impact cholesterol or their diabetes — that really doesn’t impact the heart of the disease, if you will. In order for this disease to be truly treated and truly scaled to where it’s going to have the highest impact possible, it has to be addressed through managed care and has to be addressed through pharmacists being able to have coverage for the medications for those most at need.

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