OPINION:
When you or a loved one is sick, there are many things to worry about and to understand. The price of a treatment that can help them avoid life-threatening disease events and possibly save their lives shouldn’t be one of them. That’s why we’re encouraged that manufacturers of a breakthrough class of cardiovascular drugs — PCSK9 inhibitors — are now offering them at 60 percent lower list prices.
Unfortunately, many patients are still unable to access them due to high out-of-pocket costs on some Medicare Part D health plans.
PCSK9 inhibitors dramatically lower LDL or “bad” cholesterol and help patients reduce their risk of heart attack and stroke and certain types of chest pain conditions (unstable angina) requiring hospitalization in adults with cardiovascular disease. These therapies especially have a high success rate in patients who inherit high LDL cholesterol and are unable to lower their levels with diet and exercise alone, together with other cholesterol-lowering medicines as tolerated.
As doctors, providers and leaders of organizations focused on African-American and Hispanic health, we have spent our careers fighting for greater access to care and treatment options for minority populations. Cardiovascular disease (CVD) is the leading cause of death in the U.S., and it impacts minorities significantly as they often lack awareness or do not have access to the care they need.
African-Americans experience high rates of CVD; 44 percent of men and 48 percent of women have CVD, including heart disease and strokes, per the Centers for Disease Control and Prevention. In fact, African-Americans have the highest death rates from CVD, which are easily premature deaths. Hispanics are also often at a higher risk for CVD than non-Hispanic caucasians, and Hispanic women are often less aware of their risk factors. To make matters worse, less than a third receive any cholesterol treatment, according to a 2015 study from the AHA.
While the lower list price of PCSK9 inhibitors opens avenues of access for minority and especially low-income heart patients, there is still more work to be done. Because these class of drugs are often placed on the “non-preferred brand tier” by Medicare Part D, many patients are prevented from gaining access to them because of their high out-of-pocket costs. When patients don’t fill their prescriptions, it can increase their risk for adverse cardiac events such as a heart attack or stroke.
According to a new Avalere study, “most Part D plans have shifted PCSK9 inhibitors to non-preferred tiers, which can be associated with higher OOP [out-of-pocket] costs than the specialty tier.” The study finds that “almost 60% of Part D beneficiaries will face cost sharing of $100 per month or more to access PCSK9 therapies” in 2020.
Centers for Medicare and Medicaid Services has spoken out on the issue. Administrator Seema Verma issued a letter about PSCK9 inhibitors in June. In her letter, she states PCSK9 inhibitors should not be placed on the specialty tier, as a result of the lower list price, “allowing Medicare beneficiaries access to these drugs at lower cost tiers.”
But this still isn’t happening for many Medicare Part D patients. Payers must do their part by accepting the lower list price of these life-saving drugs and work toward approving more patients. Payers can step up to help our patients by covering at least one PCSK9 inhibitors on a preferred, lower cost sharing tier, ensuring all patients get the CVD treatments they need at a more affordable rate.
The Association of Black Cardiologists (ABC) and the National Hispanic Medical Association (NHMA) work to increase access on behalf of all patients through ABC’s Access to Care initiative and NHMA’s Cardiovascular Leadership Summits. There are incredible treatment options that can help African-American and Hispanic patients have a higher quality of life. But if they are denied access to these treatments because of high out-of-pocket costs, then they will experience unnecessary barriers from living their healthiest lives. Accepting the lower list price is a big step in the right direction, but it’s up to payers to do their part.
• Keith C. Ferdinand, MD, is professor of medicine at the Tulane University School of Medicine, the Gerald S. Berenson Endowed Chair in Preventive Cardiology and the chair of the Association of Black Cardiologist’s Access to Care Working Group. Elena V. Rios, MD, is president and CEO of the National Hispanic Medical Association, representing Hispanic physicians in the United States.
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