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Access to powerful new cholesterol-lowering drugs is so tightly controlled and patients’ out-of-pocket costs are so high that fewer than a third of people whose doctors prescribe the drugs get them, a new study found.
While highly effective, the new drugs cost as much as $14,000 annually, leading some insurers and pharmacy benefit managers to require doctors to get preapproval for them.
For example, only 47.2 percent of people who were prescribed the drugs, Praluent and Repatha, received that insurance green light, and just under two-thirds of those patients filled their prescriptions.
In the end, only 30.9 percent of people who were prescribed the drugs received them, researchers found.
These injectable drugs, called PCSK9 inhibitors, dramatically reduce levels of “bad” LDL cholesterol in the bloodstream by blocking a receptor on the surface of liver cells that is needed to recycle cholesterol and maintain it in the body.
They are aimed at people whose LDL cholesterol levels remain high even when they take the maximum dose of regular statin drugs as well as those who have familial high cholesterol. Even with preapproval, patient copayments of up to $2,822 per month discouraged many from filling their prescriptions, the study found.
Whether a patient picked up the prescription was driven almost entirely by the out-of-pocket cost, said Ann Marie Navar, a clinical cardiologist and researcher at Duke Clinical Research Institute, who was the study’s lead author. It was published online in JAMA Cardiology.