The high cost of two drugs called PCSK9s introduced in 2015 for significantly lowering LDL cholesterol—Repatha (evolocumab) and Prauluent (alirocumab)—have forced some payers to deny members access because of the drugs’ more than $14,000 a year price tags; however, the medications have proved to perform as promised.
“Healthcare executives should proactively develop guidelines to determine who can qualify for these agents. For example, adults with heterozygous familial hypercholesterolemia, an inherited condition that causes high levels of LDL cholesterol in the blood, might be good candidates, as they see a larger risk reduction following treatment than other patients,” Rubin says.
Andrew Lyle, director of business development for Curexa, a compounding and specialty pharmacy, says the two drugs have difficulty gaining approval from payers and are expensive. “Doctors are trying to write prescriptions for them but they require prior authorization and other step therapies. And they don’t make any sense if members are not compliant.”