Costs, Health Insurers Impede Patients’ Access to Cholesterol-Lowering Drugs

Dr. Ann Marie Navar

Fewer than one-third of patients prescribed a new medication actually received therapy

Most prescriptions for a class of drugs heralded as game-changers for people with stubbornly high cholesterol are going unfilled because of high out-of-pocket costs and challenges by pharmacy benefit managers, according to a study from the Duke Clinical Research Institute.

Publishing online Sept. 27 in JAMA Cardiology, the Duke researchers found that fewer than one-third of patients prescribed a PCSK9 inhibitor -- injectable drugs designed to lower cholesterol levels -- actually got the drug.

Two factors limited access: lack of insurance approval for the prescription and high copays. Fewer than half of patients prescribed a PCSK9 inhibitor ever received approval for the drug by their insurer.

Even after approval, one in three patients failed to fill their prescription. Sticker shock was a key factor. A quarter of patients had copays over $300 per month for therapies that cost about $14,000 a year.The net result was that just 31 percent of patients who were initially prescribed a PCSK9 inhibitor ever actually received the therapy, the researchers found.

“This study basically reveals a system of rationing by roadblocks,” said lead author Ann Marie Navar, M.D., Ph.D., assistant professor of medicine at the Duke Clinical Research Institute. “Access comes down to patients whose doctors are persistent enough to win payer approval through multiple appeals, and patients who can afford the out-of-pocket costs.”

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