PCSK9 Coverage: Payers Wrestling With Proving Statin Intolerance
Executive Summary
Confirmation of statin intolerance is likely to be among extensive prior authorization requirements that must be satisfied before payers approve coverage for the new class of cholesterol-lowering drugs.
You may also be interested in...
CVS Health Seeks Return To LDL Treatment Targets To Control PCSK9s
Broad nature of latest cholesterol treatment guidelines makes it hard to deploy utilization management programs to control use of pricey new PCSK9 inhibitors, CVS Health argues in JAMA editorial.
Cholesterol Guidelines Look High And Low: Statin Market Extended At Both Ends
In shifting away from specific targets and non-statin add-on therapies, new ACC/AHA cholesterol guidelines support treatment of people at relatively low risk for events and more intensive therapy for those at higher risk.
GLP-1 Coverage Restrictions In Medicare Part D Surge As Demand For Obesity Drugs Grows
A major shift from unfettered coverage to prior authorizations was recorded by MMIT over the past year for the leading GLP-1/GIP agonist diabetes drugs. Public interest in using the drugs off label for weight loss drove the change.