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. 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. 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. 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. 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. 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.