“This is a very troubling and frankly dangerous finding,” said Alliance for Patient Access Executive Director Brian Kennedy. “The patients prescribed this medicine have extremely high LDL cholesterol, and statins alone are not sufficient to reduce their risk of heart attack. With these new cholesterol-lowering drugs, patients’ risk of heart attack decreases, yet insurance companies are too often refusing to cover the medicine.”
PCSK9 inhibitors work by extending the lifespan of a receptor on the liver that clears “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.
The Institute for Patient Access report card highlights the 13 Texas health plans that process the most PCSK9 inhibitor claims, ranking them based on the number of rejections issued. The least patient-friendly plans were the Federal Employee Benefit Plan, with a rejection rate of 91%, and Express Scripts at 73%. Also denying claims at a far higher rate than the state average were Teacher Retirement System of Texas TRS, 64%, and Wellcare Management Group, 61%. Humana Health Plan, Tricare Military Health SVC SYS and Aetna had the lowest rejection rates, though they still denied roughly 30% of claims.
This report card is one in a series to be released by the Institute for Patient Access in 2017 to highlight barriers to patient access.
Institute for Patient Access
PCSK9 Inhibitors Texas Report Card
Alliance for Patient Access