Cardiology Rx Trends: A Review for ACC

Mar 12, 2015
A summary of current and future trends for high blood cholesterol and high blood pressure medications.
  • Commercial
  • High Blood Cholesterol
  • High Blood Pressure/Heart Disease

According to the 2014 Express Scripts Drug Trend Report, spend for both high blood cholesterol and high blood pressure medications decreased in 2014, yet with patient populations each totaling more than 70 million American adults, both classes continue to rank in the top 5 costliest traditional therapy classes.

Components of Trend for the Top 10 Traditional Therapy Classes

Both conditions have proven, effective prescription therapies available that, when taken properly, can help patients avoid more serious – and costly – cardiac events such as heart attack or stroke. The wide variety of generic medications for both conditions helps keep treatment affordable for payers and patients.

As physicians and researchers gather this weekend at the 64th Annual American College of Cardiology meeting to discuss the latest approaches to cardiac care, we offer this summary of prescription trends and a look at the impact of future innovation on spending for these common conditions.

Current Trends: High Blood Cholesterol

High Blood Cholesterol

Spending on medications to treat high cholesterol – the second costliest traditional therapy class based on per-member spend – decreased 6.8% in 2014, largely fueled by market saturation of generic drugs. Atorvastatin, the generic for Lipitor®, is the most commonly used medication in this class. High blood cholesterol medications are also the 2nd costliest class of drugs for the Medicare population.

Although updated guidelines published in late 2013 call for treatment based on risk factors rather than for the achievement of specific cholesterol levels, significant changes in prescribing patterns have yet to be seen.

Commercial spend for conventional cholesterol-lowering medications is forecast to decline for the next several years as a result of decreases in both price and utilization. Patent expirations for the last remaining brand statin, Crestor® (rosuvastatin), in January of 2016, and Zetia® (ezetimibe) and Vytorin® (ezetimibe/simvastatin) in 2017, are expected to spur an even faster decline in spend.

Current Trends: High Blood Pressure

High Blood Pressure Heart Disease

Spend for medications used to treat high blood pressure and heart disease decreased 12.6%. Generic medications made up 93.5% of total 2014 market share, in part due to the availability of generic Diovan® (valsartan), which had been delayed by legal issues for more than a year.

This therapy class had the highest number of prescriptions per member among the top 10 traditional classes. It was the 5th costliest traditional class of medications for commercial plans, the 4th costliest among Medicare plans and the 10th costliest for Medicaid plans.

Overall, Express Scripts anticipates a decline in spend for high blood pressure medications due to stagnant use and increased availability generics in the class.

A Look Ahead: PCSK9 Inhibitors and Neprilysin Inhibitors

Although generic availability will help continue the downward trend in both classes over the next three years, new therapies for either of these highly prevalent conditions have the potential to generate significant increases in spend, and in the case of high blood cholesterol, may significantly increase the number of Americans using specialty medications a few years from now.

New biologic medications for high blood cholesterol, known as PCSK9 inhibitors, may come to market this summer. While primarily for patients with a genetic condition that leaves the body unable to remove low-density lipoprotein (LDL) cholesterol, their potential for expanded use means some patients will likely move from low-cost generic statins to high-cost biologics, impacting drug spend significantly. Annual drug costs for each patient who transitions to the PCSK9 inhibitors will jump from less than one hundred dollars to several thousand dollars.

Projected to command an annual cost as high as $10,000 per patient, and potentially reaching a patient population eventually as large as 10 million Americans, PCSK9 inhibitors alone could one day cost the U.S. healthcare system an estimated $100 billion per year.

A new class of medications for high blood pressure, called neprilysin inhibitors, may see its first drug submitted for FDA approval in 2015. Currently known as LCZ696, this drug containing the angiotensin receptor blocker valsartan and sacubitiril may have blockbuster potential. Larger-than-expected adoption could impact trend considerably.

While these new discoveries can help patients who do not respond optimally to currently available treatment, their potential cost and use among these expansive patient populations is a concern for payers.

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Lab Staff
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