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. 2021 Aug 26;10(17):3828.
doi: 10.3390/jcm10173828.

Trends in PCSK9 Inhibitor Prescriptions before and after the Price Reduction in Patients with Atherosclerotic Cardiovascular Disease

Alex Smith  1 , Drew Johnson  2 , Joshua Banks  3 , Scott W Keith  3 , Dean G Karalis  2
Affiliations

Trends in PCSK9 Inhibitor Prescriptions before and after the Price Reduction in Patients with Atherosclerotic Cardiovascular Disease

Alex Smith et al. J Clin Med. .

Abstract

Background: Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors reduce low-density lipoprotein (LDL) cholesterol and cardiovascular event rates, yet due to their high price remain underutilized and difficult to prescribe in clinical practice. In March 2018, their price was significantly reduced. We evaluated whether the price reduction would improve prescribing patterns of PCSK9 inhibitors in eligible patients with atherosclerotic cardiovascular disease (ASCVD).

Methods: We identified the number of eligible ASCVD patients and those prescribed a PCSK9 inhibitor for each year between July 2015 and December 2019. Patient demographics and clinical characteristics for those prescribed a PCSK9 inhibitor were extracted from their electronic health record.

Results: In total 1059 patients of eligible patients received a new prescription for a PCSK9 inhibitor. From 2015 to 2019, the rate of new prescriptions among eligible patients increased from 0.5 to 3.3% (p < 0.001) and continuation rates increased from 18 to 60% (p < 0.001). Following the price reduction, patients who were prescribed a PCSK9 inhibitor were younger and more likely to be female, but less likely to have Medicare insurance.

Conclusions: Despite the reduction in the cost of PCSK9 inhibitors, most eligible patients are not prescribed one. The reduction in cost has improved adherence, primarily in patients with commercial insurance. Older patients and those on Medicare still face significant barriers in accessing a PCSK9 inhibitor. Further reductions in the price of the PCSK9 inhibitors are needed as is further study of the barriers that exist in prescribing one.

Keywords: PCSK9 inhibitors; atherosclerotic cardiovascular disease; lipids.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Number of new, continued, and discontinued PCSK9 inhibitor prescriptions from 2015 to 2019. # = number; Rx = prescription; PCSK9 = proprotein convertase subtilisin kexin type 9.
See this image and copyright information in PMC

References

    1. Sabatine M.S. PCSK9 inhibitors: Clinical evidence and implementation. Nat. Rev. Cardiol. 2018;16:155–165. doi: 10.1038/s41569-018-0107-8. - DOI - PubMed
    1. Sabatine M.S., Giugliano R., Keech A.C., Honarpour N., Wiviott S.D., Murphy S.A., Kuder J.F., Wang H., Liu T., Wasserman S.M., et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N. Engl. J. Med. 2017;376:1713–1722. doi: 10.1056/NEJMoa1615664. - DOI - PubMed
    1. Schwartz G.G., Steg P.G., Szarek M., Bhatt D.L., Bittner V.A., Diaz R., Edelberg J.M., Goodman S.G., Hanotin C., Harrington R.A., et al. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N. Engl. J. Med. 2018;379:2097–2107. doi: 10.1056/NEJMoa1801174. - DOI - PubMed
    1. Karalis D.G., Mallya U.G., Ghannam A.F., Elassal J., Gupta R., Boklage S.H. Prescribing Patterns of Proprotein Convertase Subtilisin-Kexin Type 9 Inhibitors in Eligible Patients with Clinical Atherosclerotic Cardiovascular Disease or Heterozygous Familial Hypercholesterolemia. Am. J. Cardiol. 2018;121:1155–1161. doi: 10.1016/j.amjcard.2018.02.002. - DOI - PubMed
    1. Cohen J.D., Cziraky M.J., Jacobson T., Maki K.C., Karalis D.G. Barriers to PCSK9 inhibitor prescriptions for patients with high cardiovascular risk: Results of a healthcare provider survey conducted by the National Lipid Association. J. Clin. Lipidol. 2017;11:891–900. doi: 10.1016/j.jacl.2017.04.120. - DOI - PubMed

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