Currently Viewing:
The Academy of Managed Care Pharmacy (AMCP) 2019
Trust Is the Key Ingredient in Medicaid Value-Based Contracts, Manufacturers and Payers Agree
March 26, 2019
Keeping an Eye on Increasing Competition in the Specialty Drug Pipeline
March 27, 2019
Dr Sebastian Schneeweiss on How Rapid-Cycle Analytics Can Identify High-Risk, High-Cost Patients
March 27, 2019
Dr Crescent Moore Outlines Part D Changes to Expect in 2020
March 27, 2019
The Balancing Act of Using Pharmacy Strategies to Fight the Opioid Epidemic
March 27, 2019
Current and Future Status of Drug Pricing Reform as the Blueprint Approaches the 1-Year Mark
March 27, 2019
Dr Steven Pearson: ICER Can Provide More Information When a Drug is Approved With Limited Data
March 28, 2019
Sophie Schmitz on the Importance of Considering Value of Gene Therapies, Not Just Cost
March 28, 2019
Currently Reading
Managing Cholesterol With PCSK9 Inhibitors and Overcoming Operational Challenges in Practice
March 28, 2019
Dr Michael Steinman Discusses Effective Strategies for Improving Medication Management
March 29, 2019
Costs of Living With HIV Can Be Mitigated by Rapid Initiation of ART Post Diagnosis
March 29, 2019
Real-Time Prescription Benefit Checks Could Provide Accurate Cost Estimates at the Point of Prescribing
April 01, 2019
Dr Brian MacDonald Explains How Technology Can Improve Patient Management Strategies
April 10, 2019
Dr Crescent Moore on the Effect of Step Therapy in MA Plans, Other Formulary Regulations
April 13, 2019
Dr Michael Steinman on the Importance of Medication Management Strategies for Older Adults
April 15, 2019
Dr Sebastian Schneeweiss: How Payers Can Benefit From Rapid-Cycle Analytics of Real-World Evidence
April 19, 2019
Dr Crescent Moore on Implementing Care Coordination Programs in Medicare
April 25, 2019
Dr Sebastian Schneeweiss Discusses How Rapid-Cycle Analytics Can Evaluate Drug Safety, Efficacy
May 01, 2019
Dr Michael Steinman Details Opportunities for Improving Medication Management Strategies
May 05, 2019
Dr Crescent Moore Outlines CMS' Efforts to Address the Opioid Epidemic
May 13, 2019
Dr Sebastian Schneeweiss: In 5 Years, Rapid-Cycle Analytics Will Account for Majority of Analyses
May 15, 2019
Dr Jane Barlow on Innovations, Limitations Within Alternative Payment Models
January 14, 2020

Managing Cholesterol With PCSK9 Inhibitors and Overcoming Operational Challenges in Practice

Laura Joszt
Panelists discuss what PCSK9 inhibitors are, the evidence to support them, and challenges with operationalizing them in practice.
Recent trials have cemented evidence that PCSK9 inhibitors reduce cardiovascular events and fewer prescriptions are being rejected by health plans, according to panelists at a session hosted by The American Journal of Managed Care® and Pharmacy Times Continuing Education at the Academy of Managed Care Pharmacy (AMCP)’s Managed Care and Specialty Pharmacy Annual Meeting.

Ty J. Gluckman, MD, FACC, FAHA, medical director, Center for Cardiovascular Analytics, Research, and Data Science, Providence Heart Institute, led a discussion on what PCSK9 inhibitors are, the evidence to support them, and challenges with operationalizing them in practice with panelists Seth S. Martin, MD, MHS, FACC, FAHA, FASPC, associate professor of medicine, Johns Hopkins University School of Medicine; Joseph J. Saseen, PharmD, professor and vice chair, University of Colorado Anschutz Medical Campus; and Sheila L. Stadler, PharmD, BCPS-AQ Cardiology, CLS, clinical pharmacy specialist, Kaiser Permanente Colorado, and clinical assistant professor, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.

In 2013, when the first blood cholesterol guidelines came out, the message was that evidence supported statin-based therapy, explained Saseen. However, by 2018 there had been 4 major landmark trials that built off prior knowledge and only 1 of those trials was about statins, the other 3 were about non–statin-based therapies, which gave evidence about where to place non-statin drugs, like PCSK9 inhibitors and ezetimibe in the treatment of patients with cardiovascular risk.

The new guidelines still have the 4 statin benefit groups that are target populations for interventions and they’re now bucketed into primary prevention and secondary prevention. In primary prevention, the overall theory is that lower is better of low-density lipoprotein (LDL) cholesterol. Three of the statin benefit groups fall under primary prevention:
  • Patients with very high cholesterol values of 190 mg/dL and greater. High-intensity statin therapy is recommended.
  • Patients with diabetes.
  • Patients without diabetes who have higher cardiovascular risk.
Patients in this primary prevention group are eligible for not only statin therapy, but also ezetimibe after they have maximized statin therapy.

The high-risk populations with known atherosclerotic cardiovascular disease (ASCVD) are in the secondary prevention group. With this group, patients start with high-intensity statin therapy and if they don’t meet the goal, then that is the indication to go beyond statin therapy. When a patient goes beyond statins, the first option is ezetimibe and there is also clinical information that PCSK9 inhibitors can be used in 2 of the groups: patients with cholesterol of at least 190 mg/dL and those with clinical ASCVD.

Another high-risk condition for cardiovascular events is familial hypercholesterolemia (FH), which is an inherited disorder of very high levels of cholesterol. These patients have elevated levels even at a young age. There are 3 key genes: APOB, LDLR, and PCSK9. There are also 2 types of FH: heterozygous, where the gene is inherited from 1 parent, and homozygous, where genes are inherited from both parents. Homozygous is the more severe type with levels of cholesterol that can get as high as 900 mg/dL or 1000 mg/dL, said Stadler.

Heterzygous FH is pretty common and affects 1 in 250 patients. Once clinicians identify a patient meeting the criteria, it is important to make the patient aware of their FH not only so they know their own risk but also to inform their family members.

“…If we can identify and treat people [with FH] can it reduce overall, not just the morbidity for them, but also costs for the health system, too,” Stadler said.

Related Articles

Cholesterol-Fighter Repatha Gains PCSK9 Edge With CV Label Change
Perspectives of a Lipidologist: LDL Cholesterol Testing, PCSK9 Inhibitors
Study Finds Prior Authorization Mandates for PCSK9 Drugs Raise Questions of Access
Amgen Announces 60% Reduction in List Price of PCSK9 Inhibitor Evolocumab
Copyright AJMC 2006-2020 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up