Prescribed a PCSK9i? May be tough to actually receive

Prescribed a PCSK9i? May be tough to actually receive
October 26, 2017
RxLocal Team

According to Centers for Disease Control and Prevention (CDC), about 71 million American adults suffer from high cholesterol. Only a third of those suffering from high cholesterol are actually receiving treatment needed.[1]  PCSK9 inhibitors are a new class of monthly or bimonthly injectable drugs designed to significantly lower cholesterol levels. However, patients’ access to those novel therapies are found to be limited due to disputes of effectiveness vs cost. Cost to insurance companies and/or patients comes at a list price of around $14,000 per year for these new therapies.[2]

According to research, patients prescribed PCSK9 inhibitors face challenges, such as low approval rates, as stated by[3] In a recent study published in JAMA Cardiology, researchers explored patient access to PCSK9i through examined pharmacy data from the Symphony Health Solutions database for those prescribed PCSK9i. The study also examined the type of payor that was involved with each patient.

Below is a breakdown of what the study provided:

  • 45,029 patients were involved in the study.
  • Only 20.8% of patients received approval the first day and 47.2% eventually received approval.
  • Of those who were approved, 65.3% filled the prescription. Which, we calculated that roughly only 30% overall received therapy.
  • Prescription abandonment was associated with high co-pay costs at a 75% abandonment rate for copays above $350.
  • Researchers were able to establish that a person’s likelihood of receiving therapy is significantly dependent on the payor and approval policies.

Because of the high cost of PCSK9, payors have established rigorous authorization practices that lead to high patient copays. Again, this goes back to effectiveness vs cost disputes insurance companies are having with the drug makers. Another study published by JAMA Cardiology concluded the prices for PCSK9i’s would need to drop to $5459 per year to reach the commonly accepted $100,000 quality-adjusted life year threshold.  Drug makers continue to support the list prices set, and leaders for these companies have spoken of performance-based deals with insurance companies to prove effectiveness.  We will stay tuned as more studies continue to be published.

As a reminder, your independent pharmacies are always ready to help navigate the waters for any specialty or high cost medication that may require prior authorizations, patient assistance or other services. They tend offer more personalized services, training, and education on all medications from simple to complex treatments.

[1] PCSK9 Inhibitors: A New Class of Cholesterol Busters. L. Anderson, Pharma. 2017 Aug 14. Accessed: 2017 Nov 1.
[2] Updated Cost-effectiveness Assessments of PCSK9 Inhibitors From the Perspectives of the Health System and Private Payers.
Arrieta, Alejandro, PhD1; Hong, Jonathan C., MD, MHS2; Khera, Rohan, MD3. 2017 Oct 18. Accessed: 2017 Nov 1
[3] Few Patients Prescribed PCSK9 Inhibitors Actually Receive the Therapy. Unknown. 2017 Oct 8. Accessed:2017 Nov 1.