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MMIT Reality Check on PCSK9 Inhibitors (Jan 2018)

Posted by Matt Breese on Jan 31, 2018

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According to our recent payer coverage analysis for PCSK9 inhibitors, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT's team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: Medical and pharmacy benefit market access snapshots reveal some trends in payer coverage. Prior authorization and step edit policies still dominate the landscape, with nearly 100% penetration for formularies that list PCSK9s.

Source: MMIT data as of Q1 2018

Trends:  Recent news related to PCSK9 products shows some key trends in this market. One particular study from the Lipid Journal demonstrates the same general trend, with prescribing barriers still dominant. As expected, the small target population for PCSK9s results in a low volume of utilization. Due to the high cost and lack of long-term outcomes data, some prescribers hesitate to prescribe these products just yet. The largest PBMs, like Express Scripts, develop programs that combine discounts and create a spending cap for participating payers, which also serves to throttle utilization.

To read the full Reality Check on PCSK9s with key findings on clinical characteristics, PCSK9 drug market access and payer coverage, please click on the button below: 


View Reality Check

Topics: Specialty, Market Access, Branding & Marketing