Cost-effectiveness of PCSK9 Inhibitor Therapy

Mastey, Vera; Johnstone, Bryan M.

doi:10.1001/jama.2016.16286

Cited by 2 publications

(2 citation statements)

References 4 publications

(4 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The high retail cost of PCSK9i therapy has led to significant debate about their cost-effectiveness and optimal price points . In response to these costs, payors have implemented various utilization management strategies including prior authorization requirements and patient cost-sharing (copays).…”

Section: Discussionmentioning

confidence: 71%

“…The high retail cost of PCSK9i therapy has led to significant debate about their cost-effectiveness and optimal price points. [3][4][5] In response to these costs, payors have implemented various utilization management strategies including prior authorization requirements and patient cost-sharing (copays). While these strategies have contained costs, 6 our analysis suggests that these practices may be a blunt instrument to identify those at highest risk or those who may benefit the most.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of Prior Authorization and Out-of-pocket Costs With Patient Access to PCSK9 Inhibitor Therapy

et al. 2017

View full text Add to dashboard Cite

IMPORTANCE Although PCSK9 inhibitors (PCSK9i) were approved in 2015, their high cost has led to strict prior authorization practices and high copays, and use of PSCK9i in clinical practice has been low. OBJECTIVE To evaluate patient access to PCSK9i among those prescribed therapy. DESIGN, SETTING, AND PARTICIPANTS Using pharmacy transaction data, we evaluated 45,029 patients newly prescribed PCSK9i in the United States between 08/01/2015 and 07/31/2016. MAIN OUTCOMES AND MEASURES Main outcomes were: the proportion of PCSK9i prescriptions approved and abandoned (approved but unfilled); multivariable analyses examined factors associated with approval/abandomnent including payor, prescriber specialty, pharmacy benefit manager (PBM), out-of-pocket cost (copay), clinical diagnoses, lipid lowering medication use, and low density lipoprotein cholesterol (LDL-C) levels. RESULTS Of patients given an incident PCSK9i prescription, 20.8% received approval on the first day, and 47.2% ever received approval. Of those approved, 65.3% filled the prescription, resulting in 30.9% of those prescribed PCSK9i ever receiving therapy. After adjustment, patients who were older, male and had ASCVD were more likely to be approved, but approval rates did not vary by patient low density lipoprotein (LDL-C) level nor statin use. Other factors associated with drug approval included: having government versus commercial insurance (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.8–3.8), and those filled at a specialty versus retail pharmacy (OR 1.96, 95% CI 1.66–2.33). Approval rates varied nearly 3-fold among the top 10 largest PBMs. Prescription abandonment by patients was most associated with copay costs (c-statistic 0.86); with abandonment rates ranging from 7.5% for those with $0 copay, to more than 75% for copays greater than $350. Limitations include that the analysis was conducted in the first year of availability before outcomes trials results. CONCLUSIONS AND RELEVANCE In the first year of availability, only half of patients prescribed a PCSK9 received approval, and one third of approved prescriptions were never filled due to copay.

show abstract

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Association of Prior Authorization and Out-of-pocket Costs With Patient Access to PCSK9 Inhibitor Therapy

et al. 2017

View full text Add to dashboard Cite

show abstract

Use of Low‐Density Lipoprotein–Lowering Therapies Before and After PCSK9 Inhibitor Initiation

Rymer

Mues

Monda

et al. 2020

JAHA

View full text Add to dashboard Cite

Background Proprotein convertase subtilisin/kexin type 9 inhibitors ( PCSK 9i) are used to reduce low‐density lipoprotein ( LDL ) cholesterol. PCSK 9i use after initiation, as well as persistence with or alterations to other LDL ‐lowering therapy after PCSK 9i initiation, is not well understood. Methods and Results We conducted a retrospective study of alirocumab or evolocumab ( PCSK 9i) new users from July 2015 to December 2017 in the MarketScan Early View database of US commercial insurance beneficiaries. We determined the prevalence of PCSK 9i interruption (≥30‐day gap in supply) and LDL ‐lowering therapy use in the year after PCSK 9i initiation. The average age of 6151 patients initiating PCSK 9i therapy was 63 years, 44.4% were women, and 76.8% had atherosclerotic cardiovascular disease. Overall, 52.2% (95% CI , 50.8%–53.7%) of patients had an interruption in PCSK 9i therapy in the first year after treatment initiation and 62.5% remained on PCSK 9i therapy at 1‐year postinitiation. Also, 27.7% of patients were taking a statin at the time of PCSK 9i initiation, with only 22.4% on statin therapy at 1 year after PCSK 9i initiation. Ezetimibe use decreased from 20.9% at the time of PCSK 9i initiation to 12.0% a year later. By 1 year after PCSK 9i initiation, 44.0% of patients had experienced an interruption in all LDL ‐lowering therapies, and 26.6% were no longer on any LDL ‐lowering therapies. Conclusions After PCSK 9i initiation, statins were often discontinued, whereas more than half of patients experienced an interruption in PCSK 9i therapy. These results suggest that many new PCSK 9i users may remain at high risk for cardiovascular events because of interruptions in LDL ‐lowering therapy.

show abstract

Cost-effectiveness of PCSK9 Inhibitor Therapy

Cited by 2 publications

References 4 publications

Association of Prior Authorization and Out-of-pocket Costs With Patient Access to PCSK9 Inhibitor Therapy

Association of Prior Authorization and Out-of-pocket Costs With Patient Access to PCSK9 Inhibitor Therapy

Use of Low‐Density Lipoprotein–Lowering Therapies Before and After PCSK9 Inhibitor Initiation

Contact Info

Product

Resources

About