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When cholesterol drugs cost $14,000, an insurance tug-of-war

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Nearly 2 years after PCSK9 inhibitors were approved by FDA, doctors and patients say getting insurance to pay for the cholesterol drugs, which list for more than $14,000 a year before rebates or discounts, is a battle that requires countless hours, applications, and appeals.

Nearly 2 years after PCSK9 inhibitors were approved by FDA, doctors and patients say getting insurance to pay for the cholesterol drugs, which list for more than $14,000 a year before rebates or discounts, is a battle that requires countless hours, applications, and appeals. Even then, the battle for insurance approval of PCSK9 inhibitors is successful less than one-half the time, according to several recent studies. Some doctors believe PCSK9 inhibitors could be a lifesaving solution for millions of heart-disease patients and could transform treatment for the most difficult cases—patients with familial hypercholesterolemia, as well as those with a history of heart disease or stroke for whom statins and other therapies are inadequate. Drug companies estimated the target population to be 11 million patients. But other doctors say that until drug companies can prove PCSK9 inhibitors will reduce the number of deaths caused by heart disease, not just their ability to reduce heart attacks and strokes, the drugs are not worth the high price. Doctors and researchers say part of the reason PCSK9 inhibitors are priced so high is because they are a fully human monoclonal antibody, which is harder to manufacture than a normal pill. Patients inject them into their bodies every 2 to 4 weeks. Health insurers and their consultants say PCSK9 inhibitors have less-expensive alternatives in statin drugs. They also say that the PCSK9 drugs are a lifelong prescription at a high cost.

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https://www.wsj.com/articles/when-cholesterol-drugs-cost-14-000-an-insurance-tug-of-war-1497889667

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