The first of two cholesterol-lowering PCSK9 inhibitors (Proprotein Convertase Subtilisin/Kexin type 9) is expected to be approved by the U.S. Food and Drug Administration (FDA) as early as this week. To determine appropriate coverage of these new drugs, Prime analyzed its claims data and confirmed current statin treatments were not being used or adhered to as guidelines recommend. Adherence to statins is a long-standing national problem which is well studied and documented. Not surprisingly, Prime’s analysis validates there is a significant opportunity to optimize statin use even for members who may be eligible for PCSK9s.
What we studied
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 percent were considered high-risk for cardiovascular disease.
What we learned
Prime found that only 1 in 5 members at risk for cardiovascular disease 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 percent of people at high-risk for cardiovascular disease significantly underuse statins.
Why we did this study
The coming PCSK9 drugs are estimated to cost between $7,000 and $12,000 per year, and there are no generic alternatives. This could add up to $0.93 to $6.71 per commercial member per month, based on how broadly these drugs are used. Prime’s analysis highlights the opportunity to improve statin use, even among members who may be eligible for PCSK9s. Clinically appropriate use of statins could help to reduce demand for these costly new specialty treatments.
Review the study poster, presented Oct. 26–29, 2015 at the Academy of Managed Care Pharmacy (AMCP) Nexus event in Orlando, Florida. >>