The second-largest pharmacy benefits manager in the United States CVS Health Corp. has asked heart specialists to rewrite the guidelines followed to treat patients with high cholesterol levels. CVS, which manages drug-benefit plans for the country’s insurers and employers, has made this recommendation after the launch of some new and expensive medications.
This unusual move by the pharmacy benefits manager is the most recent development in the fight on increasing US healthcare costs with insurers adopting a range of aggressive tactics for extracting steep discounts from drug manufacturers. The insurers are using similar tactics even for new medications launched onto the market and controlling patients’ access to the majority of the expensive drugs.
In a letter, CVS has said that the existing guidelines, which include a particular method for assessing an individual’s chances of having heart disease rather than assessing specific targets for levels of LDL or bad cholesterol, fail to clearly explain how to pick the most cost effective and useful therapy.
According to CVS, right now it’s important to have LDL targets as recently the US Food & Drug Administration (FDA) has approved a new cholesterol drug called Praluent. This new drug launched by Regeneron Pharmaceuticals Inc and Sanofi SA is capable of blocking PCSK9, a protein known for its ability to help LDL cholesterol remain in our bloodstream.
That’s not all; FDA is expected to announce its decision about another PCSK9 inhibitor, Repatha by Amgen Inc, sometime this month.
US pharmacy benefits managers including CVS have expressed concerns about the price of PCSK9 inhibitors, which appears to be much more expensive than the previously used cholesterol medications like statins. Statins in generic form require patients to spend less than $50 per month. Praluent, on the other hand, is given by injection and would require you to spend around $15,000 annually.
Studies have shown that both Praluent and Repatha, when used along with statins, can lower cholesterol levels by more than 60% of what statins can do alone.
According to CVS’ chief scientific officer Dr. William Shrank, the existing cholesterol guidelines fail to explain clearly how these new cholesterol drugs will fit in the treatment model. Dr. Shrank feels that this lack of clarity might lead to a situation where doctors might consider prescribing a PCSK9 inhibitor to low-risk patients.