PCSK9 Coverage: Payers Wrestling With Proving Statin Intolerance
Confirmation of statin intolerance is likely to be among extensive prior authorization requirements that must be satisfied before payers approve coverage for the new class of cholesterol-lowering drugs.
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Broad nature of latest cholesterol treatment guidelines makes it hard to deploy utilization management programs to control use of pricey new PCSK9 inhibitors, CVS Health argues in JAMA editorial.
In shifting away from specific targets and non-statin add-on therapies, new ACC/AHA cholesterol guidelines support treatment of people at relatively low risk for events and more intensive therapy for those at higher risk.
Investigative reports from the House Oversight and Reform Committee recount well-known records of significant price increases for the drugs, the lack of pricing restraints in the US relative to markets abroad, tactics used to protect the drugs from generic competition and the 'return on investment' from manufacturer assistance programs.