Beyond PSCK9 prices: How valuable is coronary heart disease event prevention?

PSCK9 inhibitors have been dominating the headlines. And for good reason. With annual, per-patient costs topping $14,000 — as much as 50 times the cost of highly effective, yet highly underutilized statins — they pose a substantial threat to health care affordability.1

Prime Therapeutics (Prime) works to manage the high cost of PSCK9 inhibitors by optimizing statin therapy, when appropriate. But managing drug costs is just one piece of the puzzle. Proactively managing care is just as important. When members who could benefit from cholesterol-lowering drug therapy aren’t being treated optimally, or at all, they’re at greater risk for coronary heart disease (CHD) events — and plan sponsors are on the hook for higher overall health care costs.

What we studied

To learn just how valuable CHD event prevention is, Prime studied the incidence of CHD events* and the associated incremental costs. Our research team analyzed pharmacy and medical claims data from nearly 6 million commercial members from nine health plans.

What we learned

When analyzing the data, we learned that:

  • Of the members studied, 62 percent had claims evidence of a CHD event.
  • Incremental claim costs for CHD events — across the medical and pharmacy benefit — were $56,233, on average.
  • Nearly 30 percent of CHD events occurred in members with artherosclerosis cardiovascular disease. Nearly one-third of these members had no record of any statin therapy in the year prior to the three-year study period in which the event occurred.

Why we did this study

Health plans strive to identify and help members at increased risk of CHD events who are not receiving appropriate drug therapy or are having difficulty with adherence. Understanding the total cost of CHD events can help health plans assign value to managed care strategies. Implementing these strategies can not only help control the overall cost of care — it can help make sure people get the medicine they need to feel better and live well.

Learn more

Review the study poster, presented Oct. 26–29, 2015 at the Academy of Managed Care Pharmacy (AMCP) Nexus event in Orlando, Florida. >>

Read the press release.

*CHD events were identified by medical claims for myocardial infarction, coronary revascularization, two or more claims for stable or unstable angina, peripheral arterial disease, transient ischemic attack, or ischemic stroke, or pharmacy claim for a nitrate, platelet aggregation inhibitor or intermittent claudication agent.

 

1. Managed Healthcare Executive. (2015, September 2). High cost of new PCSK9 inhibitors could plague payers. Retrieved from managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/high-cost-new-pcsk9-inhibitors-could-plague-payers

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Senior Health Outcomes Researcher


Kevin applies his keen mind and unique perspective to the study of integrated medical and pharmacy data. His insights help Prime and its clients understand current trends and predict future patterns of drug use and costs.