Frequent Recurrence Obviated by Suppressive Therapy (FROST)

The Frequent Recurrence Obviated by Suppressive Therapy (FROST) initiative is a quality improvement pharmacy initiative to educate individuals with frequent outbreaks of herpes simplex about the benefit of chronic suppressive treatment for outbreak reduction and prevention of transmission. This initiative shares educational information with members that have had 6 or more acute prescriptions for herpes medication over the past year. Specialized pharmacy support is available to answer questions or concerns regarding treatment options based on guidelines issued by the Center for Disease Control and Prevention (CDC).

Within Medco Health Solutions, Inc.’s approximately 65 million covered lives, approximately 1.8 million members are prescribed valacyclovir or acyclovir each year. Approximately 50% initiate the therapy due to a diagnosis of herpes simplex (HSV1 or HSV2) and approximately 35% of patients with genital herpes have frequent outbreaks, defined has 6 or more outbreaks per year. Randomized controlled clinical studies have shown that long-term, daily suppressive therapy can reduce recurrence of genital herpes in patients with frequent outbreaks from 11.4 outbreaks per year to 1.8 outbreaks per year on average. However, only about 10% of patients currently use daily suppressive therapy compared to the 35% who have frequent outbreaks. The majority of patients use valacyclovir or acyclovir episodically for less then 10 days when they have an acute outbreak. Unfortunately, episodic use of these therapies only decreases the length of time of the outbreak instead of reducing the frequency of outbreaks. In addition, patients are more likely to shed the virus to others during periods of recurrence. The diminished use of chronic suppressive therapy may be due to a lack of education regarding the benefits of daily therapy, a lack of tolerability to the medications.