New clinical guidelines for cholesterol treatment could be a good thing for both physicians and patients, so long as they are used properly.
The rising price of insulin has created a multibillion-dollar business for the pharmaceutical oligopoly that controls the market — and a deep sense of anger and fear among people who need the drug to stay alive.
Americans pay more for prescription drugs than any country in the world, and the pharmaceutical industry earns billions in profits each year.
Patient advocates across the country cheered this week as news spread about a decrease in the list price of evolocumab.
Heart disease patients, providers, caregivers and stakeholders agree: Health plan policies that delay access to life-saving medication are unacceptable.
Powerful PCSK9 inhibitors were supposed to revolutionize care for cardiac patients. But insurers and other payers balked at sky-high prices.
A massive stroke marked a serious change in the weather for Mark McEwen, whose familiar face brought viewers the weather forecast on the 1990s’ “CBS This Morning.” McEwen keynoted the May 15 Cardiovascular Health Policy Summit in Washington, DC, describing how he struggled to regain speech, mobility and fine motor skills.
Heart patients in Europe have something to celebrate.
During the first year an expensive class of new cholesterol-lowering drugs was on the market, only one in three patients with a prescription actually received the therapy due to lack of insurance approval and high copays, according to a study sponsored by a manufacturer of one such drug.
Read more at Reuters Health.
STATEMENT FROM KEITH FERDINAND, MD, CARDIOLOGIST:
“ICER’s report is a disappointment for patients and physicians and other practitioners who have seen expected results with these drugs. For patients suffering with extremely high cholesterol, these medications can reduce the risk of heart attack and stroke. Unfortunately, ICER’s report could jeopardize many patient’s ability to access the life-saving medication they and their physicians and other providers have determined is the best course of care.”
A money-back deal for cholesterol-lowering PCSK9 inhibitors doesn’t cut costs enough, claims a new analysis from a University of Pittsburgh researcher. The drug’s manufacturer says the numbers used to calculate her cost figures don’t reflect reality. But the voice that’s missing from this public debate is the one that arguably has the most to lose – patients, who already struggle to access breakthrough cardiovascular therapies.
Access to PCSK9 Inhibitors
Approved by the FDA to treat patients with genetic high cholesterol and those who have already experienced a cardiac event, PCSK9 inhibitors can lower stubborn “bad” cholesterol for patients who’ve found few results with existing treatments. But the drugs’ price point has led health plans to establish extensive prior authorization processes to limit costs. A national IfPA health plan report card found that 43 percent of patients are denied access to the PCSK9 inhibitor their doctor prescribes.
Read more at Institute for Patient Access.
Florida health plans reject nearly 50 percent of claims for treatment
WASHINGTON – On Saturday, August 5, the Partnership to Advance Cardiovascular Health will host a health forum, “Advancing Cardiovascular Health & Patient Access to Innovative Therapies.” The lunchtime event in Orlando at the Florida Medical Association’s annual meeting will bring together patient advocates, clinicians, and policymakers to discuss innovations in cardiovascular therapies, high rates of cardiovascular disease in Florida and barriers that patients face in accessing new cholesterol-lowering drugs. Seth Baum, MD, founder of Excel Medical Clinical Trials and president of the American Society for Preventive Cardiology, will lead the forum.
Accessing innovative cardiovascular drugs may soon get harder.
A new publication from the Institute for Clinical and Economic Review, a drug price analysis group, assigns a C+ effectiveness grade to cholesterol-lowering drugs known as PCSK9 inhibitors. The lukewarm valuation sets the stage for increased health plan barriers, despite the drugs’ effectiveness in reducing heart attack and stroke risk.
PCSK9 inhibitors work by preventing the PCSK9 protein from destroying a receptor on the liver that clears bad cholesterol. The receptor “lives” longer, clearing more LDL cholesterol for the patient. For some patients who don’t sufficiently respond to traditional statin therapy, the drugs have offered unprecedented improvement.
Read more at Institute for Patient Access.
Petition launch coincides with cardiovascular health forum in Alabama.
WASHINGTON – On Friday, June 23, the Partnership to Advance Cardiovascular Health (PACH) will launch a petition on Change.org directed at the National Association of Insurance Commissioners in response to the alarming rejection rates that qualifying patients across the country face in accessing new, groundbreaking, cholesterol-lowering medications known as PCSK9 inhibitors. The petition will be promoted at a series of health forums on the status of cardiovascular health in states where there is an enhanced need for access to cholesterol-lowering therapies but health plan barriers remain high. Many health plans around the country are using restrictive plan designs and utilization management tools to force patients onto less effective therapies in spite of physicians’ recommendations and compelling data.
Alabama has the second highest death rate from cardiovascular disease in the country yet state health plans reject more than 50 percent of claims for treatment
WASHINGTON – On Friday, June 23, the Partnership to Advance Cardiovascular Health, along with Mended Hearts, will host “The Status of Cardiovascular Health in Alabama: A Forum.” The lunchtime event in Birmingham will bring together patient advocates, clinicians and policymakers to discuss innovations in cardiovascular therapies, high rates of cardiovascular disease in Alabama and barriers that patients face in accessing new cholesterol-lowering drugs. In an Alabama Health Plan Coverage Report Card from the Institute for Patient Access, data shows Alabama health plans reject more than 50 percent of claims for PCSK9 inhibitors.
New Video “PCSK9 Inhibitors: Access Barriers Affect Real People” Highlights Barriers to New, Breakthrough Cholesterol-Lowering Drugs
WASHINGTON – Today the Partnership to Advance Cardiovascular Health released a new web video, “PCSK9 Inhibitors: Access Barriers Affect Real People.” The video, featuring patient testimonials, explores access issues to new, breakthrough cholesterol-lowering drugs known as PCSK9 inhibitors.
New health plan report card analyzes PCSK9 inhibitor claims for managed care organizations
WASHINGTON – The Institute for Patient Access released a new Health Plan Coverage Report Card highlighting the rates at which South Carolina insurers deny patients coverage for advanced cholesterol-lowering drugs known as PCSK9 inhibitors. The report card reveals that health plans reject nearly 50 percent of claims submitted for coverage of prescribed PCSK9 inhibitors. The data, collected from August 2015 to July 2016 by a national data supplier, reflects PCSK9 inhibitor claims for South Carolina managed care organizations, including commercial plans, Medicare and managed Medicaid.