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Cardiovascular Disease

PCSK9 inhibitors are a new class of drugs that hold promise for patients who have not responded to traditionally used cholesterol lowering drugs. Unfortunately, access to PCSK9 inhibitors has been challenging, with some reports stating that only one third of patients actually get the drug after they have received a prescription for its use.

WHAT TO KNOW


What is Cardiovascular Disease?

Any disease related to your circulatory system- or heart and blood vessels- is classified as Cardiovascular Disease (CVD). These are typically chronic, progressive disorders- which means there is no cure for them, and over time without proper treatment they get worse. In some cases, CVD can lead to a heart attack or stroke, when blood flow to the heart or brain is stopped. Cardiovascular disease is very common, impacting about half of all Americans.

What are some access issues for people who have CVD?

For many people, CVD is something that can be controlled and managed provided they have access to that is prescribed by their care providers. For others however, this is not the case. Some complex CVD conditions, like Familial Hypercholesterolemia, may not have many effective treatment options for everyone. The traditional medications or interventions may not impact the disease process due to a person’s genetics. A new medication class called PCSK9 Inhibitors have been shown to make effective strides in reducing the impact of Familiar Hypercholesterolemia (or FH). Unfortunately, they are nearly impossible for some patients to access.

How do PCSK9 Inhibitors work?

PCSK9 inhibitors work by lowering LDL-C cholesterol.  They are so effective that LDL-C cholesterol is proven to be lowered even in patients who do not respond to existing cholesterol lowering statins. Lowering LDL-C cholesterol is necessary because it contributes to plaque, a built up, thick deposit that clogs blood vessels. These plaque deposits can lead to atherosclerosis, peripheral artery disease, heart attacks, or strokes. Reduced levels of LDL-C leads to a decreased risk of developing potentially life threatening medical conditions. If you already have one of the above conditions, it slows the disease progression.

Why is there difficulty accessing PCSK9 inhibitors?

While we feel no monetary value should be put on a person’s life, many health insurance companies do not include PCSK9 Inhibitors on their formularies because they are expensive and relatively new. The research showing cost-benefit analysis of PCSK9 Inhibitors compares them to other cholesterol lowering medications, like statins, which are much less money to produce. However, this looks past the fact that for many PCSK9 Inhibitors are the only option effective enough to reduce their chance of a major life-threatening event.

In this video, hear from 50-State Network advocates Cameron and Craig, along with other patients, who have overcome remarkable denials to PCSK9 Inhibitors.

WHAT TO SAY
Your talking points

Patients have a right to know the truth. PCSK9 Inhibitors are not being prescribed as much because insurance companies do not see their price as “worth it.”

2 No one understands a patient’s health better than his or her physician. Insurance companies try to claim otherwise by not including PCSK9 Inhibitors in their formularies.

3 Patient access to treatment should be determined exclusively by clinical decisions, not economic decisions.

4 PCSK9 Inhibitors are proven to be effective in the most difficult cases. Even when the standard therapy has failed, PCSK9 Inhibitors can work.

5 Though initially expensive, in the long term PCSK9 Inhibitor therapy saves medical costs from avoiding heart attacks or procedures like bypasses.

 
 

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