More than 1.3 million Americans, or 1 in 250 people, suffer from familial hypercholesterolaemia (FH), a genetic disorder that can significantly increase the risk for early heart disease and even death.
Often undistinguished from other causes of high cholesterol, FH is under-diagnosed and undertreated. However, with early diagnosis and optimal treatment, the risk for heart disease can be lowered to almost that of the general population.
PCSK9 inhibitor therapy has been a significant advance for patients with FH; however the cost of the therapy can be a significant burden for payers, particularly when these medications are used for patients who can achieve desired high blood cholesterol outcomes with less costly statin therapy.
To ensure patient safety and payer affordability, it is important to appropriately manage use of PCSK9 medications. Our Cholesterol Care Value Program℠ uses a rigorous clinical review process and specialist pharmacist support to ensure PCSK9 inhibitors are accessible when clinically appropriate, and to ensure the patients who use these medication remain adherent to their therapy.
As part of a new collaboration with the FH Foundation – the leading, patient-centered non-profit organization dedicated to FH research, advocacy, and education -- we’re enhancing our program with a more comprehensive set of diagnostic criteria to provide a broader group of patients with access to cutting-edge PCSK9 inhibitor treatment, as appropriate.
With these new, more inclusive criteria put into practice via the Cholesterol Care Value Program, patients with an untreated LDL-cholesterol (LDL-C) equal to or greater than 190 mg/dL, whose LDL-cholesterol is still over 70 mg/dL on maximally tolerated statins plus Zetia, will qualify for prior authorization for a prescribed PCSK9 inhibitor. Other diagnostic criteria to better define the condition of FH were also added.
Safety, Affordability and Adherence
Specialist pharmacists in our Accredo pharmacy have deep knowledge of FH and unique capabilities to holistically care for people living with FH.
Recently, our Cholesterol Care Value program demonstrated industry leading medication adherence rates among patients cared for by these specialist pharmacists.
Specifically, members who filled a prescription for Praluent® (alirocumab) or Repatha® (evolocumab) via Accredo, as part of the Cholesterol Care Value Program, demonstrated an adherence rate of 89.3% compared to 82.1% for the same time period at retail and other specialty pharmacies combined.
Given the cost of these medications, and the severity of disease among patients who use them, it’s important to see high medication adherence rates.
Through novel partnerships with organizations like the FH Foundation, and the work and care provided by our specialist pharmacists, we deliver the right medicine to the right patient at the right time.
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