About My Health Careers Internship MedBlogs Contact us
Medindia LOGIN REGISTER
Advertisement

Your Health Insurance may Not Cover New Cholesterol Drugs

by Rishika Gupta on October 31, 2017 at 3:34 PM
Font : A-A+

Your Health Insurance may Not Cover New Cholesterol Drugs

Evolocumab and Alirocumab, the new prescription drugs for cholesterol have lesser than half coverage ratings from the insurance companies found a new study published in Circulation, Journal of the American Heart Association.

PCSK9 inhibitors, like Repatha (evolocumab) and Praluent (alirocumab), work by increasing the removal of low-density lipoprotein (LDL) or "bad" cholesterol from the blood.

Advertisement


They have been shown to reduce LDL by 60 percent and decrease major cardiac events but cost much more than other cholesterol-lowering drugs with an average cost of $14,300 per year. Prescriptions require prior authorization by health insurance companies.

In a nationwide review of the pharmacy claims combined with Electronic Medical Records (EMRs) lab test results of 9,357 patients prescribed the drug between July 2015 and August 2016, 4,397 (47 percent) were approved for PCSK9 inhibitor therapy, and 4,960 (53 percent) were rejected.
Advertisement

Sixty percent of those patients had a history of the Atherosclerotic cardiovascular disease (plaque-build-up of the arteries) while 40 percent did not.

"With the controversy surrounding whether or not these drugs were cost effective, we were anticipating that there might be some reluctance by insurance companies to cover these medications," said senior author Robert Yeh, M.D., director of the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center in Boston.

"However, we were surprised by the very high rate of rejection, even when prescribed to patients with a known Atherosclerotic cardiovascular disease, very high LDL levels and those who were intolerant of statins, for example," he said.

Researchers also found that the most significant factor associated with approval rates was insurance type, with the lowest approval rates for private insurance and the highest approval for Medicare.

"Whether or not we can agree on the cost-effectiveness of these drugs, I believe most would agree that one's access to medications should be driven primarily by the strength of the indications for the prescription as opposed to what drug plan you happen to carry," said Yeh, who is also an Associate Professor of Medicine at Harvard Medical School.

"Approximately 1 out of 3 patients who had their prescription approved did not purchase or receive the medication. Those patients who didn't purchase their medication had an out-of-pocket cost that was twice as high as those who did purchase it," said Dr. Gregory Hess, first study author and senior fellow of Health Economics at the University of Pennsylvania and chief medical officer at Symphony Health.

The findings are based on Symphony Health's HIPPA-compliant patient-level data from all fifty states and all payer types.

"Better education for providers prescribing these medications and more uniform guidelines by insurers about what will and will not be covered are necessary to reduce the amount of administrative waste that is created to reject prescriptions for new medications," Yeh said.

The study was a retrospective analysis and could not determine whether patients suffered any harm from the rejection of these prescriptions.

Source: Eurekalert
Advertisement

Advertisement
News A-Z
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Advertisement
News Category
What's New on Medindia
Turmeric: Magic Ingredient to Keep you Healthy in Winter
Top 7 Benefits of Good Oral Hygiene
Healthy and Safer Thanksgiving 2021
View all

Medindia Newsletters Subscribe to our Free Newsletters!
Terms & Conditions and Privacy Policy.

More News on:
Cholesterol High Cholesterol Drug Toxicity Health Insurance Plan Third Party Administrators for Health Insurance Star Health and Allied Insurance Heart Attack Health Insurance Policies offered by Bajaj Allianz Insurance ICICI Lombard General Insurance Company Limited Health Insurance 

Recommended Reading
PCSK9 Inhibitors Do Not Increase Short-term Risk of Type 2 Diabetes
PCSK9 inhibitors are novel drugs used to control the levels of LDL cholesterol. A new study found .....
Updated Analysis Finds Newer Type of LDL-C Reducing Drugs Still Not Cost-effective
A cost-effectiveness analysis of PCSK9 inhibitors indicated that their 2015 price would need to be ....
Alcohol Use Affects Levels of Cholesterol Regulator
PCSK9 gene explains the differences in how cholesterol is processed in people who drink alcohol or ....
Low Levels of Bad Cholesterol tolerated in Heart Disease Patients
Some patients need to reduce their LDL cholesterol than what they are able to achieve with a ......
Cholesterol
Cholesterol is produced by the body (liver) and is essential for normal body functioning....
Drug Toxicity
Drug toxicity is an adverse reaction of the body towards a drug that results as a side effect of a d...
Health Insurance Plan
With a health insurance policy you and your family can rest assured!...
Health Insurance Policies offered by Bajaj Allianz Insurance
Bajaj allianz health insurance policies protect you and your family in case you need expensive medic...
Heart Attack
Heart attack is the death of the heart muscle due to loss of blood supply. Heart disease is the lead...
High Cholesterol
High cholesterol level in blood are a risk for heart disease and stroke. They get deposited in the w...
ICICI Lombard General Insurance Company Limited
Major health care plans from the ICICI Lombard include complete health insurance ihealth plan, perso...
Star Health and Allied Insurance
Star Health & Allied Insurance offers a convenient insurance for the corporate people when they tra...
Third Party Administrators for Health Insurance
TPA is an IRDA approved healthcare service provider. TPA processes claims for policy holders on beha...

Disclaimer - All information and content on this site are for information and educational purposes only. The information should not be used for either diagnosis or treatment or both for any health related problem or disease. Always seek the advice of a qualified physician for medical diagnosis and treatment. Full Disclaimer

© All Rights Reserved 1997 - 2021

This site uses cookies to deliver our services. By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use