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Patient Viewpoint on PCSK9 Inhibitors

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Patient Viewpoint on PCSK9 Inhibitors

  1. 1. GLOBAL CARDIOVASCULAR CLINICALTRIALISTS FORUM PatientViewpoint on PCSK9 Inhibitors Marilyn Mann November 30, 2017
  2. 2. Disclosures • American College of Cardiology: travel expenses • American Board of Internal Medicine: travel expenses • Yale Center for Outcomes Research and Evaluation: consulting fee for serving on a stakeholder advisory committee for developing a performance measure under a contract with CMS
  3. 3. An FH patient on PCSK9 inhibitors: We are rejected and/or forced through step therapy in order to get access.The copay program helps, but my first copay before it kicks in is $1000. Monthly copay is around $400 as its now a tier 4 drug on my formulary. … But it works. It works very well. And if I don’t take it, then I have no other options, besides apheresis.
  4. 4. Prior authorization practices and high copays are limiting use of PCSK9 inhibitors • During the first year of availability, 47.2% of patients prescribed a PCSK9 inhibitor received approval. • Of those approved, 65.3% filled the prescription, resulting in 30.9% of those prescribed a PCSK9 inhibitor ever receiving therapy. • Copays varied widely, from $0 for the lowest quartile of patients to more than $300 per month for the highest quartile. • Prescription abandonment by patients was most associated with copay costs, with abandonment rates ranging from 7.5% for those with $0 copay to more than 75% for copays greater than $350. Navar AM, Taylor B, Mulder H, et al. Association of Prior Authorization and Out-of-pocket Costs With Patient Access to PCSK9 Inhibitor Therapy. JAMA Cardiol. 2017;2(11):1217-1225.
  5. 5. Relationship Between Copay and Prescription Abandonment for Patients Approved for PCSK9 Inhibitors NavarAM,Taylor B, Mulder H, et al. Association of PriorAuthorization and Out-of-pocket CostsWith PatientAccess to PCSK9 InhibitorTherapy. JAMA Cardiol. 2017;2(11):1217-1225.
  6. 6. Medicare Part D plans and annual out-of- pocket costs for PCSK9 inhibitors • Alirocumab and atorvastatin 80 mg.: $4997 • Evolocumab and atorvastatin 80 mg.: $4968 Kazi DS, Lu CY, Lin GA, et al. Nationwide Coverage and Cost-Sharing for PCSK9 Inhibitors Among Medicare Part D Plans. JAMA Cardiol. 2017;2(10):1164-1166.
  7. 7. Out-of-Pocket Costs for PCSK9 InhibitorTherapy Under Medicare Part D Kazi DS, Lu CY, Lin GA, et al. NationwideCoverage and Cost-Sharing for PCSK9 InhibitorsAmong Medicare Part D Plans. JAMA Cardiol. 2017;2(10):1164-1166.