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Multidisciplinary approach may lead to more insurance approvals for PCSK9 inhibitors
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PHILADELPHIA — A multidisciplinary approach to prescribing PCSK9 inhibitors to patients resulted in a higher rate of insurance approvals, according to a poster presented at the National Lipid Association Scientific Sessions.
“Unfortunately, the insurance approval rate for patients who qualify and would benefit from PCSK9 inhibitors is quite low, hovering around the 50% to 60% range,” Vasanth Sathiyakumar, MD, a medical resident at Johns Hopkins University in Baltimore, told Cardiology Today. “In a single, tertiary care center with a specialized lipid clinic, we evaluated our experience with PCSK9 inhibitors. We had an approval rate close to 85%, which is markedly different than what the prevalence is across the country. What we really highlighted in our study was the use of a multidisciplinary approach, careful patient selection and thorough documentation to achieve that rate.”
Researchers analyzed data from 42 patients who were prescribed PCSK9 inhibitors through a multidisciplinary approach between 2015 and 2016. Cardiologists, specialty pharmacists, nurse practitioners and geneticists were involved in the process, which promoted thorough documentation and careful patient selection.
Among the cohort, 36 patients (86%; mean age, 57 years; 43% women) received insurance approval, and 35 patients started PCSK9 inhibitor therapy. Patients were either prescribed alirocumab (Praluent, Sanofi/Regeneron; 31%) or evolocumab (Repatha, Amgen; 69%), and were followed up for a median of 9.4 months.
Most patients had familial hypercholesterolemia (80%) and/or established atherosclerotic CVD (74%). Patients who received insurance approval went through exercise and dietary counseling. The majority of patients (80%) were on background ezetimibe and/or statin therapy.
LDL in patients with follow-up lipid panels was reduced by a median of 58% (interquartile range, 38-74).
Of the 35 patients administered PCSK9 inhibitors, 97% reported continued adherence and only 11% reported missing any injections, according to the researchers.
“Down the road, as PCSK9 inhibitors are recommended for further patient groups, it is important to ask ourselves if the process we employ ensures successful insurance approval for those patients,” Sathiyakumar told Cardiology Today. – by Darlene Dobkowski
Reference:
Sathiyakumar V, et al. Abstract 150. Presented at: National Lipid Association Scientific Sessions; May 18-21, 2017; Philadelphia.
Disclosure: Sathiyakumar reports no relevant financial dis