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Study: 80% of Cardiovascular Patients Significantly Underuse Statins

Pharmacy benefits manager advises members to optimize statin therapy before trying PCSK9s

The first of two cholesterol-lowering proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors is expected to be approved by the FDA within a few days. To guide its utilization management approach for these new drugs, the pharmacy benefits manager Prime Therapeutics analyzed its claims data and confirmed that current statin treatments were not being used or adhered to as guidelines recommend.

Prime analyzed more than 3.0 million members who were commercially insured and enrolled in benefits through a Prime client continuously for four years through 2014. Of those, 1.8% had established cardiovascular disease. Prime found that only 1 in 5 of these members were using a high-dose statin and were taking it regularly in 2014, which is the recommendation of the American College of Cardiology and the American Heart Association. In other words, 80% of people with established cardiovascular disease were significantly underusing statins. In addition, Prime found:

  • 27% had no statin claim in 2014.
  • Of those without a statin claim or not adherent, only 1 in 4 had tried a second statin during the 4 years.
  • 45% either had no statin claim or were not adherent to their prescribed statin therapy in 2014.

“PCSK9s may be an appropriate solution for our members with a rare genetic condition who are unable to lower their LDL [low-density lipoprotein] cholesterol levels,” said David Lassen, chief clinical officer at Prime. “However, for the majority of others struggling to lower their ‘bad’ cholesterol levels, the best and most affordable therapy is treatment with statins, which have a long track record of safety and effectiveness. Because PCSK9s have not been proven to prevent heart attacks and their long-term safety has not yet been established, we feel compelled to help our clients optimize statin therapy prior to the initiation of PCSK9s. We believe this is the right thing to do clinically for our members and the responsible thing to do as we manage the total cost of care.”

It has been reported that PCSK9 drugs could be priced at between $7,000 and $12,000 per year. At this price point, Prime previously estimated that PCSK9s could cost the U.S. health care system $23.3 billion per year if broadly used by as many as 2.3 million Americans. If used by only 40% of the more than 600,000 Americans with a rare genetic condition leading to abnormally high cholesterol levels for which statins aren’t always effective, PCSK9 drugs could still add an additional $2.1 billion per year in new costs.

When new drugs come to market, especially high-cost specialty drugs without long-term safety data, it’s important that the health care industry evaluate the clinical merit, long-term safety profile, and cost of the drug as part of the overall drug management strategy, Prime advises. The group recommends conducting a thorough review of claims history for high-risk members requesting PCSK9s to ensure that every attempt has been made to optimize the use of statins before adding PCSK9s.

Source: Prime Therapeutics; July 21, 2015.

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