On the heels of recent research confirming breakthrough drugs’ impact on patients with high cholesterol, the Partnership to Advance Cardiovascular Health has released a quick-draw video exploring obstacles for patient access.
In “Accessing Cholesterol Treatments,” narrator and cardiologist Seth Baum, MD, describes a hypothetical patient with a family history of extremely high cholesterol. “He’s not the typical cholesterol patients,” Dr. Baum explains, “And the typical medications, known as ‘statins,’ don’t lower his cholesterol enough.”
What follows has become a familiar narrative for Dr. Baum and other patients and health care providers across the country. A doctor advises the patient to make dietary changes, exercise more and continue with his statin regimen. He also prescribes a PCSK9 inhibitor, which research shows could lower the patient’s LDL cholesterol by nearly 60 percent.
But the patient’s health plan has another route in mind. A prior authorization process follows, requiring extensive and time-consuming documentation. It delays the patient’s access to his new medication, and he’s ultimately denied coverage.
Patients in such situations face more than just disappointment, the video explains. Untreated, extremely high LDL levels can lead to heart attacks, stroke and death. Yet the scenario remains common. Health plans reject three out of every four patients whose doctors prescribe a PCSK9 inhibitor.
Improving patients’ health and protecting their lives, the video explains, will require policymakers to “resolve cost disputes and provide fair access to the breakthrough cholesterol treatments that patients need.”
PACH is a nonprofit partnership that advances public policies to accelerate innovation and improved cardiovascular health around the world. The Alliance for Patient Access is a member. To learn more, visit www.advancecardiohealth.org.