Things are looking up for patients who have an uncommon heart condition. The Food and Drug Administration last month approved a novel medication to treat obstructive hypertrophic cardiomyopathy.
Treating Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy is a genetic condition that thickens the heart’s muscle tissue, threatening blood circulation and heart function. In rare cases, it can cause heart failure.
Now a first-in-class medication called mavacamten can reduce obstructions of the blood vessels for people with the disease. Clinical testing has shown the drugto be highly effective for as many as four out of five patients with obstructive hypertrophic cardiomyopathy.
The medication can increase the amount of exertion the heart can stand, called functional capacity. It also reduces symptoms, such as chest pain and shortness of breath, and can minimize the need for surgery.
The possibility of timely, effective treatment stands in stark contrast to the current standard of care for the 750,000 Americans affected by the disease. Many have a protracted path to diagnosis, if they ever get one.
Because hypertrophic cardiomyopathy’s symptoms vary and can masquerade as other cardiovascular conditions, only 15% of patients receive the diagnosis they need to begin targeted treatment.
Keeping an Eye on Coverage Decisions
With the approval of mavacamten, hypertrophic cardiomyopathy isset to join the ever-growing number of chronic but treatable conditions. That is, if insurers will cover the new medication.
“New-to-market exclusions” keep patients from getting their medication covered for a period, 30 or 60 days, or even until the next coverage year. But being around for a year or more doesn’t guarantee coverage either.
Insurers and their pharmacy benefit managers continue to exclude more drugs from their formularies every year. The “big three” pharmacy benefit managers – CVS Caremark, Express Scripts and OptumRx – each exclude 400-500 medications.
A reliable treatment for obstructive hypertrophic cardiomyopathy could improve patients’ quality of life. It also has potential to save patients and the health care system money down the road by offsetting the need for intensive procedures. Both benefits can only be realized, though, if insurers embrace the opportunity.
