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Barriers to PCSK9 inhibitor prescriptions for patients with high cardiovascular risk: Results of a healthcare provider survey conducted by the National Lipid Association
Journal article   Open access   Peer reviewed

Barriers to PCSK9 inhibitor prescriptions for patients with high cardiovascular risk: Results of a healthcare provider survey conducted by the National Lipid Association

Jerome D Cohen, Mark J Cziraky, Terry A Jacobson, Kevin C Maki and Dean G Karalis
Journal of clinical lipidology, v 11(4), pp 891-900
Jul 2017
DOI: https://doi.org/10.1016/j.jacl.2017.04.120
PMID: 28550993
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
http://www.lipidjournal.com/article/S1933287417302581/pdfView
Published, Version of Record (VoR) Open
url
https://doi.org/10.1016/j.jacl.2017.04.120View
Published, Version of Record (VoR) Open

Abstract

Cardiovascular Diseases - blood Cardiovascular Diseases - drug therapy Cholesterol, LDL - blood Drug Prescriptions - statistics & numerical data Health Personnel - statistics & numerical data Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects Hydroxymethylglutaryl-CoA Reductase Inhibitors - pharmacology Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Proprotein Convertase 9 - antagonists & inhibitors Protease Inhibitors - pharmacology Protease Inhibitors - therapeutic use Societies, Medical Surveys and Questionnaires
Statin therapy is recommended for reducing atherosclerotic cardiovascular disease (ASCVD) risk. Significant risk can remain because of insufficient clinical response or statin intolerance. Proprotein convertase subtilisin/kexin type-9 (PCSK9) therapy lowers low-density lipoprotein cholesterol and has recently been shown to lower ASCVD events. The aim of the study was to assess the barriers and challenges experienced with the access and approval reimbursement process for PCSK9 inhibitor prescriptions. In 2016, the National Lipid Association conducted an online survey on PCSK9 inhibitor use and barriers to prescription among experienced healthcare workers who provide care to high-risk patients with ASCVD or familial hypercholesterolemia (FH). There were 434 respondent healthcare workers with extensive experience in treating lipid disorders. PCSK9 inhibitors are considered by 71.3% of respondent providers with statin-intolerant patients. There were high rates (>85%) of initial denial. The major barriers to approvals were insurer processes, provider documentation (inadequate documentation of maximally tolerated statin dose, diagnostic criteria for FH, number of statins failed if statin intolerant and most recent low-density lipoprotein cholesterol), and administrative burden (time, staff, paperwork, and appeals). Provider approval rates for getting ≥75% patients approved were higher for FH (43%) than for ASCVD patients (36%). Among providers with good approval rates, documentation was the most critical factor. Barriers more difficult to overcome include perceived higher threshold requirements by payers, drugs not on formulary, and drug costs. Healthcare providers encounter significant barriers to PCSK9 inhibitor prescriptions; many of these are related to documentation issues and can be overcome with checklists, staff support, and experience.

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60 citations in Web of Science
54 citations in Scopus

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UN Sustainable Development Goals (SDGs)

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Industry collaboration
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Web of Science research areas
Pharmacology & Pharmacy
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