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Expected PCSK9 Inhibitor Reimbursement after FOURIER

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May 03, 2017
We interviewed two health insurance medical directors to gain insight into current prior authorization (PA) for the PCSK9 inhibitors and how that will change, if at all, with the FOURIER cardiovascular outcomes trial (CVOT) results, which were presented at the recent American College of Cardiology meeting. Topics discussed include the likely impact of FOURIER on both large and small insurance plans, how the results were viewed and which endpoints insurers focus on, whether they are willing to extrapolate results to later years, risk sharing arrangements, how stronger results could affect PA, potential effects if the label is broadened with an LDL-C lowering indication for primary prevention groups other than familial hypercholesterolemia (particularly on Medicare plans which would be required to cover the new indications), physician demand, and dynamics for novel drugs entering later.

The drugs discussed include Repatha (AMGN, Astellas), Praluent (REGN, SNY), inclisiran (MDCO, ALNY, ABUS), and ETC-1002 (ESPR).

If you are a KOL Insight Subscriber, please access both interviews (interview 1 and interview 2) from our KOL Insight portal (Subscribers only).

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Indications Covered: Dyslipidemia / Hypercholesterolemia
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