The Partnership to Advance Cardiovascular Health (PACH) released a video on May 1, 2017 that addresses the access barriers to PCSK9 inhibitor and how it affects real people. The video, featuring patient testimonials, explores access issues to new, breakthrough cholesterol-lowering drugs known as PCSK9 inhibitors.
These patients, some with a genetic condition called Familial Hypercholesterolemia (FH), are at increased risk for cardiac events such as heart attack and stroke because of extremely high levels of LDL or “bad” cholesterol. While new clinical trials data have definitively linked the drugs to improved outcomes such as lowered stroke and heart attack risk, health plan barriers exist. Data released by the Institute for Patient Access in a series of Health Plan Coverage Report Cards show that health plans in many states are denying a majority of PCSK9 claims, sometimes at rates as high as 90 percent.
The video, filmed at a town hall hosted by the American Society for Preventive Cardiology (ASPC) in Washington, D.C., highlights patient testimonials and the concerted effort by health care providers to overcome these remarkable denial rates. At the town hall, ASPC announced uniform prior authorization and appeal forms to help make the process easier for patients and physicians to get PCSK9 coverage.
PCSK9 inhibitors work by extending the lifespan of a receptor on the liver that clears LDL, or “bad” cholesterol. Clinical trials data show that PCSK9 inhibitors can lower LDL cholesterol more than statins alone and can also reduce the associated risks of heart attack and stroke.