What’s it like to prescribe the most expensive cardiovascular medication in U.S. history? A team of researchers out of Portland wrote about their experience with the drug in JAMA Cardiology, noting that considerable time was taken with each patient to make sure they could afford it.
Tafamidis, manufactured by Pfizer, received FDA approval in May 2019 for the treatment of transthyretin amyloid cardiomyopathy (ATTR-CM). It has a list price of $225,000 per year.
The analysis covered 50 consecutive patients who were prescribed the drug from May to November 2019 at the Oregon Health & Science University Multidisciplinary Amyloidosis Program in Portland. All 50 patients were men, though women were not intentionally left out of the study—there were just none among those initial 50 patients.
All but one patient had prescription insurance. While 76% of patients had Medicare Part D, 12% had private insurance, 4% had VA insurance and another 6% had “other types” of copayment assistance.
A total of 7 patients (14%) did not successfully obtain tafamidis after receiving the prescription. Of that cohort, three patients simply could not afford the out-of-pocket cost, two patients “declined further attempts at drug procurement,” one patient died before receiving the drug and one patient enrolled in a research study instead.
The median and mean out-of-pocket costs for a 30-day supply of tafamidis were $1,909 and $3,082, respectively, before financial assistance. Insurance providers covered a mean of 89% of the total cost. Thirty percent of patients received copayment assistance from the manufacturer. Patients who qualified for financial assistance paid nothing.
The authors noted that, as the systems are set up today, copayment programs are essential for tafamidis to reach the hands of the very patients who need it.
“The most pertinent regulation to patients is that the assistance should be based on reasonable and consistent measures of financial need, requiring certain thresholds to be put in place under which patients may qualify for assistance,” wrote lead author Ahmad Masri, MD, MS, Oregon Health & Science University, and colleagues. “There are many elderly individuals who do not qualify for assistance based on these thresholds but have other preexisting competing financial commitments that prohibit them being able to afford the costly copayments. In addition to these eligibility stipulations, the funds in these nonprofit foundations are liable to run out. We have experienced periods during which programs have closed temporarily, causing tremendous uncertainty for patients.”
Masri et al. also wrote explained that great care was taken to ensure patients could afford the medication. “An integrated multidisciplinary amyloidosis program, a specialty pharmacy and a dedicated pharmacist” would all work with each individual patient as a part of that process.
The full analysis is available here.
Back in February, an analysis from Circulation noted that the price of tafamidis needed to be reduced by a whopping 92.6% for it to be accessible to the general public.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.