Many Patients Prescribed PCSK9 Inhibitors Do Not Receive Them

Only a third of patients who are prescribed PCSK9 inhibitors ever receive them, according to the results of a recent study.

The high cost of PCSK9 inhibitors has been associated with lower rates of use in clinical practice. In order to evaluate patient access to PCSK9 inhibitors, researchers conducted a study of data from 45,029 patients prescribed the drugs between August 1, 2015 and July 31, 2016.

The main outcomes of the study were the proportion of PCSK9 inhibitor prescriptions approved and abandoned (unfilled). Factors associated with approval and abandonment, including prescriber specialty, pharmacy benefit manager, out-of-pocket costs clinical diagnoses, lipid-lowering medication use, and low-density lipoprotein cholesterol levels were evaluated with multivariable analyses.

Overall, 20.8% of patients given prescriptions for PCSK9 inhibitors received approval on the first day, and 47.2% received approval at any point after prescription. Of those approved, 65.3% of patients filled the prescription, resulting in 30.9% of patients prescribed PCSK9 inhibitors ever receiving them.

Age, male sex, and the presence of atherosclerotic cardiovascular disease were associated with higher likelihood of approval. Other factors included insurance type, and specialty vs retail pharmacy.

Copay costs were most associated with prescription abandonment, with rates ranging from 7.5% among those with a $0 copay to over 75% for those with copays greater than $350.

“In the first year of availability, only half of patients prescribed a PCSK9i received approval, and one-third of approved prescriptions were never filled owing to copay,” the researchers concluded.

Reference:

Navar AM, Taylor B, Mulder H, et al. Association of prior authorization and out-of-pocket costs with patient access to pcsk9 inhibitor therapy [published online September 27, 2017]. JAMA Cardiology. doi:10.1001/jamacardio.2017.3451.