Abstract
Introduction: Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of morbidity and mortality worldwide. There have been many advances in the lipid management of these patients from statin therapy to the more recent PCSK9 inhibitors. PCSK9 inhibitors (PCSK9i) have been shown to reduce cardiovascular events in patients with ASCVD. Despite their efficacy, there have been challenges to physicians adopting widespread use of PCSK9i, particularly cost. Our goal is to evaluate PCSK9i utilization in a real world setting before and after reduction in costs of PCSK9i. Methods: We retrospectively reviewed a large metropolitan outpatient cardiology practice EMR database to evaluate the demographics of their patient population as well as individual prescriber habits to determine their utilization of PCSK-9i before and after the price reduction in March 2016. All data were compared using χ 2 and student t-test via IBM SPSS version 25. Results: Patients were included if they had a diagnosis of ASCVD and had been seen once between January and December 2019. Among eligible patients, despite reduction in cost, only 4.1% (1059 of 25749) were prescribed a PCSK9i. Compliance with PSCK9i from 2015 to 2019 improved from 20% (9 of 45) to 68% (215 of 316). The percentage of patients with insurance approval for a PCSK9i via commercial carriers increased by over 10% after the 2016 price decrease (31.0% [155 of 500] to 41.3% [231 of 559], P<0.001). Data can be seen in Table 1. Conclusions: In a large metropolitan cardiology practice, of over 25,000 patients eligible for a PCSK9i, only 4.1% were actively prescribed. Although compliance increased over threefold over the study period, there are still clear barriers to prescribing and compliance with PCSK9i. Despite the cost reduction, women and older patients were less likely to be treated with a PCSK9i. Additional barriers exist for prescribing for eligible patients, particularly in older women.
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