High cost blocks access to effective cholesterol drugs

Sarah Sipek | | Cardiovascular Business | Interventional Cardiology

Lowering cholesterol—especially LDL cholesterol—is proven to reduce the risk of heart attacks and deaths. A new class of drugs has been shown to lower LDL levels to that of a 6-month-old baby, but patients are being denied access due to its high cost.

In a new 18-month study involving 968 heart patients, PCSK9 inhibitors combined with a statin dropped their LDL levels to an average of 36, with some getting their levels down to 10. The National Institutes of Health considers anything under 100 to be ideal.

While effective, cost prohibits many patients from gaining access to the drug. Amgen’s version of the drug—Repatha—has a list price of $14,000 a year. And most insurers refuse to pay.

Physicians are forced to submit extensive documentation about the patient’s need for the drug. Despite this information, insurers deny 80 to 90 percent of claims at first. Doctors can appeal, but the process is administratively arduous.  

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Study Shows Promise for Expensive Cholesterol Drugs, but They Are Still Hard to…

Sarah Sipek

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