Association of Prior Authorization and Out-of-pocket Costs With Patient Access to PCSK9 Inhibitor Therapy

• DOI: 10.1001/jamacardio.2017.3451
• Publication Date: 2017-10-03T18:32:24Z
• Authors: Ann Marie Navar; Benjamin Taylor; Hillary Mulder; Eugene Fievitz; Keri L. Monda; Anna Fievitz; Juan F. Maya; J. Antonio G. López; Eric D. Peterson
• Keywords: Prior authorization

Although PCSK9 inhibitors (PCSK9i) were approved in 2015, their high cost has led to strict prior authorization practices and copays, use of PSCK9i clinical practice been low.To evaluate patient access PCSK9i among those prescribed therapy.Using pharmacy transaction data, we evaluated 45 029 patients who newly the United States between August 1, July 31, 2016.The proportion prescriptions abandoned (approved but unfilled); multivariable analyses examined factors associated with approval/abandonment including payor, prescriber specialty, benefit manager, out-of-pocket (copay), diagnoses, lipid-lowering medication use, low-density lipoprotein cholesterol levels.Of given an incident prescription, 51.2% women, 56.6% 65 years or older, 52.5% had governmental insurance. Of a 20.8% received approval on first day, 47.2% ever approval. approved, 65.3% filled resulting 30.9% receiving therapy. After adjustment, male, atherosclerotic cardiovascular disease more likely be rates did not vary by level nor statin use. Other drug included having government vs commercial insurance (odds ratio [OR], 3.3; 95% CI, 2.8-3.8), at specialty retail (OR, 1.96; 1.66-2.33). Approval varied nearly 3-fold top 10 largest managers. Prescription abandonment was most copay costs (C statistic, 0.86); ranging from 7.5% for $0 than 75% copays greater $350.In year availability, only half approval, one-third never owing copay.