How Can Health Plans Save $124 Per Member Per Year?

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The estimated cost per quality-adjusted life year for the PCSK9 drugs is $300,000. How should health plans respond?

I am pretty sure most of the readers of The American Journal of Managed Care are earning a lot of money, but now there is a $300,000 per year opportunity (or approximately $150 per working hour) open to nearly any American…namely the cost of the benefit of taking one of the PCSK9 drugs. That is the estimated cost for an additional year of life for those taking this new class of drugs that decrease cholesterol levels at a cost of about $14,000 per year per person.

Currently, 27% of American adults have an elevated cholesterol that could potentially be the target for this class of drugs. If only 5% of these took the drug, the premium for your health insurance would rise by $124 next year. That would buy you a lot of happy meals, which, in turn, might allow you to benefit from these drugs!


Much has been written about the cost of pharmaceutical agents and health plans are lamenting the rapid rise of this drug class, but little is being done to actually get to the root causes of our national crisis—obesity, metabolic syndrome, pre-diabetes, lack of exercise, and lack of adherence to evidence-based guidelines—many of which demand the initiation of much less expensive statins to control the same problem. The CDC states that about 1 in 3 adults in the US need to be referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention (and I might add adherence to drugs to control the consequences of this bad behavior). The problem is, where do we find this type of counseling?

Existing programs are insufficient to perform this level of activity.

Only digital medicine offers the ability to scale to this level of need. The use of a virtual health assistant is inevitable. But when will insurers and retail pharmacies (who have publicly stated they want to be the keepers of our primary healthcare needs) step up and accept the role of protecting our collective health by incorporating effective and cutting edge cognitive technologies into their offerings?

There is a growing body of evidence that virtual assistants can significantly affect outcomes. Now is the time to start to deploy this technology.

Or perhaps you would rather have the $300,000 per year solution?