This week in managed care, the top stories included new data on statin prescriptions, a trial found the PCSK9 inhibitor Repatha successfully lowered cholesterol, but an editorial said the price might be too high to be worth it, and Farzad Mostashari, MD, discussed care transformation.
Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care. Welcome to This Week in Managed Care, from the Managed Markets News Network
Statin Results From Express Scripts
This week, in an AJMC exclusive, the pharmacy benefits manager Express Scripts presented data that surprised experts who treat heart disease.
In late 2013, the American College of Cardiology and the American Heart Association replaced their old cholesterol treatment guidelines with a cardiovascular risk calculator, which would guide physicians in prescribing statins. But many doctors rejected the guidelines and said they would not follow them.
Now, data from Express Scripts, presented last Sunday at the ACC meeting in Chicago, show that new statin prescriptions, dose changes, and drug changes all fell in the first year of the new guidelines—an unexpected result.
Dr Spencer Gaskin of Washington University in St. Louis told AJMC that it’s not clear why this is happening, and he’s waiting for more data. Said Dr Gaskin: “I’m curious what we’ll see at the 2-year mark.”
PCSK9 Inhibitor Results, Price
A unique trial presented at ACC showed that the PCSK9 inhibitor evolocumab, sold by Amgen as Repatha, did a far better job than ezetimibe in lowering cholesterol in patients who were shown to be statin intolerant.
Results from the Cleveland Clinic, presented by cardiologist Dr Steven Nissen, involved a 2-step trial in which patients who had repeatedly failed on statin therapy were first tested on atorvastatin and placebo in a crossover trial. Only those patients who could not tolerate atorvastatin proceeded to the next phase.
Among these patients, evolocumab lowered LDL or “bad” cholesterol 52%, compared with 17% for ezetimibe.
But in an editorial, JAMA wrote that the price of evolocumab is too high for it to be prescribed widely to patients who have statin intolerance.
Right now, both approved PCSK9 inhibitors cost about $14,000 a year, and the editorial said to be cost-effective, the drugs would need to be $2600 a year. The JAMA writers found: “A patient at very high risk for a cardiovascular event with intolerable muscle symptoms while taking even a low statin dose should be considered as a candidate for this treatment. Less than 1% of all ‘statin-intolerant’ patients might belong to this group at present. For other patients with statin intolerance, the appropriateness of these agents is less clear.”
Drug Value Assessment
The value of cancer drugs is in the eye of the beholder.
A younger patient might be willing to tolerate side effects from a powerful, life-saving therapy, while an older patient might be more concerned about quality of life and cost. This is the idea behind the Evidence Blocks, a framework that is gaining more acceptance within the National Comprehensive Cancer Network.
Dr Robert Carlson, the NCCN’s chief executive officer, discussed Evidence Blocks at the group’s 21st annual conference, where he outlined how these tools can help oncologists discuss treatment options with patients. Said Dr Carlson: “NCCN members have some operational assumptions. Panelists are specifically told not to consider cost when generating guidelines. Cost is not considered when an agent or a regimen is chosen based on a Guideline, but cost information should be available in decision making.”
For more coverage from the NCCN annual conference, click here.
Are we making strides in providing value-based care? Dr Farzad Mostashari, chief executive of Aledade, drew a distinction between progress in payment and progress in care delivery during a recent conversation with AJMC. Watch the video here.
If you want to learn more about care transformation, join us April 28-29 in Scottsdale, Arizona, for the spring meeting of the ACO & Emerging Healthcare Delivery Coalition.
For information and to register, visit the conference page.
For all of us at the Managed Markets News Network, I’m Justin Gallagher. Thanks for joining us.