What Price Reductions for Cholesterol-lowering Medications Mean for Patients

October 26, 2018

Patient advocates across the country cheered this week as news spread about a decrease in the list price of evolocumab.  The medication is a PCSK9 inhibitor – a “cholesterol buster” that can lower high LDL cholesterol when traditional statins alone are not effective.

Innovative and potentially lifesaving, PCSK9 inhibitors are also expensive.  But prices are dropping.

Earlier this year, manufacturers slashed the price of the PCSK9 inhibitor alirocumab.  And now a lower list price could also make evolocumab more accessible for patients.  Medicare patients, as well as some patients with commercial health insurance, are responsible for paying a percentage of their medication’s list price.  This week’s announcement could expand access for patients who previously couldn’t afford the medication.

But there’s one caveat: Insurers must reduce other barriers, specifically onerous prior authorization and step therapy processes.  Since PCSK9 inhibitors first became available, insurers have imposed these practices as delay tactics with the goal of protecting their own bottom line.  National data show one in four heart patients can’t access their physician-prescribed PCSK9 inhibitor.

As recent media attention attests, the results for patients can be devastating – and dangerous.  While physicians wade through health plans’ red tape, patients are unnecessarily exposed to the risk of heart attack, stroke and even death.  

A September survey from the Partnership to Advance Cardiovascular Health underscored public concern about these practices.  Eighty-eight percent of respondents in the national survey agreed it was “unreasonable” for health plans to delay access for at-risk patients, while 84 percent characterized the practice as “dangerous.”  

The consequences of untreated high cholesterol are too significant to limit options to a life-saving medication.  One-third of the country has high LDL cholesterol, a primary risk factor for heart disease. Expanding access to PCSK9 inhibitors can improve the health of hundreds of millions of Americans.  

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