TRENDS IN PCSK9 INHIBITOR COSTS, COST SHARING, AND ADHERENCE AMONG MEDICARE BENEFICIARIES FOLLOWING 2018 PRICE REDUCTIONS
Author(s)
Julia (Yinuo) Wang, PharmD, MS, Christopher Blanchette, PhD, MBA, Chintan Dave, PhD, PharmD;
Rutgers University, Center for Health Outcomes, Policy, and Economics (HOPE), Piscataway, NJ, USA
Rutgers University, Center for Health Outcomes, Policy, and Economics (HOPE), Piscataway, NJ, USA
OBJECTIVES: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), alirocumab and evolocumab, provide effective LDL-C lowering for patients who need additional therapy beyond maximally tolerated statins. However, their initial launch was characterized by high list prices, which created substantial barriers to access. Although manufacturers subsequently implemented substantial price reductions in 2018, the extent to which these reductions have improved patient affordability, adherence, and persistence remains uncertain. Accordingly, the aim of this study was to evaluate national trends in PCSK9 inhibitor costs, adherence, and persistence among Medicare beneficiaries.
METHODS: We conducted a retrospective cohort study using Medicare Fee-for-Service Part D claims from 2016-2021. Adults aged ≥65 years with ≥1 PCSK9 inhibitor fill and ≥12 months of continuous enrollment prior to and after initiation were included. Outcomes included patient out-of-pocket (OOP) costs, Medicare drug spending, and one-year treatment adherence, measured by proportion of days covered (PDC≥80%). One-year persistence was defined as continuous therapy without a >60-day gap. Costs were inflation-adjusted and standardized to 30-day supply equivalents.
RESULTS: Among 63,961 PCSK9i (mean age 73.7 years; 53.9% female), the mean Medicare spending for a 30-day prescription declined by 60% from $889 (2016) to $354 (2021), whereas the mean patient OOP costs declined more modestly (32%) from $231 to $157. One-year adherence increased from 49.1% in 2016 to 57.8% in 2020 (+8.7 percentage points), and one-year persistence increased from 56.0% to 63.8% (+7.8 percentage points). Year-to-year gains were most pronounced from 2018 to 2019, coinciding with an immediate reduction in costs and a concomitant increase in adherence.
CONCLUSIONS: List price reductions for PCSK9i more substantially lowered Medicare spending but resulted in more modest improvements in patient OOP costs. Although adherence and persistence improved over time, persistent patient cost-sharing may continue to limit patient access.
METHODS: We conducted a retrospective cohort study using Medicare Fee-for-Service Part D claims from 2016-2021. Adults aged ≥65 years with ≥1 PCSK9 inhibitor fill and ≥12 months of continuous enrollment prior to and after initiation were included. Outcomes included patient out-of-pocket (OOP) costs, Medicare drug spending, and one-year treatment adherence, measured by proportion of days covered (PDC≥80%). One-year persistence was defined as continuous therapy without a >60-day gap. Costs were inflation-adjusted and standardized to 30-day supply equivalents.
RESULTS: Among 63,961 PCSK9i (mean age 73.7 years; 53.9% female), the mean Medicare spending for a 30-day prescription declined by 60% from $889 (2016) to $354 (2021), whereas the mean patient OOP costs declined more modestly (32%) from $231 to $157. One-year adherence increased from 49.1% in 2016 to 57.8% in 2020 (+8.7 percentage points), and one-year persistence increased from 56.0% to 63.8% (+7.8 percentage points). Year-to-year gains were most pronounced from 2018 to 2019, coinciding with an immediate reduction in costs and a concomitant increase in adherence.
CONCLUSIONS: List price reductions for PCSK9i more substantially lowered Medicare spending but resulted in more modest improvements in patient OOP costs. Although adherence and persistence improved over time, persistent patient cost-sharing may continue to limit patient access.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PT25
Topic
Health Policy & Regulatory
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)