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MMIT Reality Check on PCSK9 Inhibitors

Posted by Matt Breese on Dec 10, 2015

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Touching a network across healthcare in pharma, payer and provider, MMIT's team of experts takes a closer look at PCSK9 inhibitors in our most recent Reality Check. The following brief highlights some of our key takeaways from the piece.

Payer Coverage: Nearly half of U.S. lives feature covered or better status. However, payers representing 29% of Americans choose not to cover PCSK9 inhibitors on formularies.rc-pcsk9.png

Source: MMIT data as of Q4 2015

Trends:  Several leading health plans and PBMs establish clear preferences for one product over the other on commercial formularies. Drug Store News highlights one example where CVS Health announced its decision to exclusively cover Repatha. The first two quarters with cholesterol lowering drugs such as PCSK9 drugs and inhibitors on the U.S. market reveals slow growth for the two products. However, manufacturer discounts steadily improve product access. 

Key Findings: Manufacturer contracting with payers proves difficult with the prevalence of cost-control strategies that block access. As expected, Medicare formularies feature more restrictive access for patients while commercial and managed medicaid formularies relax access. The unique environment in the market incites more creative payer utilization management approaches. Prior authorization policies reveal restrictive-to-label policies for almost half of U.S. covered lives. Developing injectable agents in the pipeline could result in an interesting market access landscape upon entry. Industry experts expect bococizumab to be the first to join the existing two products on the market.

In the full Reality Check on PCSK9 inhibitors below, MMIT's team of experts takes a deeper look into the clinical characteristics, drug market access and payer coverage to summarize key findings within the class.

View Reality Check

Topics: Market Access