Praluent® and Repatha®, two PCSK9 inhibitors (proprotein convertase subtilisin/kexin type 9) were approved last summer by the U.S. Food and Drug Administration (FDA). These first-of-its-kind drugs treat a rare genetic condition in which high cholesterol can’t be lowered with the use of traditional statins. They also treat people with established cardiovascular disease.
This co-preferred decision applies to Prime’s commercially insured population, which represents nearly 25 million lives.
“After carefully evaluating both drugs and consulting with our payers, we’re extremely confident co-preferring the PCSK9 inhibitors offers the best care and competitive savings for our members and clients,” said Pete Clagett, senior vice president for integrated care and specialty at Prime. “Our independent pharmacy and therapeutic review process deemed these products to be clinically equivalent. Similar pricing, a narrow indication by the FDA, and our management to appropriate use, curbed use of PCSK9 inhibitors out of the gate, so we were able to take our time and make a thoughtful decision.”
Most pharmacy benefit managers have allowed use of PCSK9 inhibitors for secondary prevention to prevent heart attacks. However, Prime’s Cholesterol Best in Care™ drug management program has been effectively managing the appropriate use of these two expensive, yet important new therapies.
Prime estimates savings of nearly $30 million for clients since these drugs were launched.
Additionally, Prime’s previous analysis shows that 80 percent of people with cardiovascular disease significantly underuse statins. This presents a significant opportunity to optimize statin use even for members who may be eligible for PCSK9 inhibitors.
Generic statins are priced at pennies on the dollar and PCSK9 inhibitors cost more than $14,000 per year. Careful management of PCSK9s and driving statin use is clearly the responsible approach. Careful management is also necessary for another reason—drug makers haven’t completed additional clinical trials to prove these drugs can reduce heart disease and prevent heart attacks. Until then, use of these drugs should be limited.