OBJECTIVES

The proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) alirocumab and evolocumab were approved by US FDA in 2015 for the treatment of hypercholesterolemia. The objective of this study was to estimate the extent of prescribing of these medications and associated expenditure within the Medicare Part D population in 2016, overall and by U.S. state and region.

METHODS

We analyzed the 2016 Medicare Provider Utilization and Payment Data Public Use File to assess state prescribing and expenditure for PCSK9 inhibitors among those aged 65 years or older. United States Census Bureau data were used to determine the number of people 65 years of age or older in each state and geographic division, which we applied to estimate the prescribing rate (PR) and expenditure rate (ER) per 100,000 persons aged 65 years or older. States were also clustered to analyze geographic divisions.

RESULTS

In 2016 there were an estimated 32,874 prescriptions for alirocumab, totaling $39,797,900 (standard deviation (SD) $6,706,413), and 17,767 prescriptions for evolocumab totaling $21,020,085 (SD: $3,969,766). The states with the highest rates of PCSK9i utilization were Louisiana (PR: 234.2; ER: $272,437 (SD: $31,235), Kansas (PR: 212.0; ER: $241,533 (SD: $26,714), and West Virginia (PR: 202.6; ER: $230,360 (SD: $25,644) while the lowest prescribing rates were for South Dakota (PR: 9.6; ER: $10,672), Wyoming (PR:14.1; ER: $12,036), and Vermont (PR: 26.4; ER:$31,571 (SD: $1,840). West South Central had the highest PR at 134.2 and ER of $157,927 (SD: $22,625) and New England had the lowest at 62.4 and ER of $71,628 (SD: $10,305).

CONCLUSIONS

Prescribing rates and expenditure for PCSK9 inhibitors varied across states and geographic divisions. While these patterns suggest different utilization of this novel therapy among Medicare Part D enrollees geographically, further research is needed to determine if these differences reflect variation in either quality of care or medication access.