Association of Prior Authorization and Out-of-pocket Costs With Patient Access to PCSK9 Inhibitor Therapy

Abstract

Since 2015, 2 PCSK9 inhibitors (PCSK9i), alirocumab and evolocumab, have been approved for adults with persistently elevated low-density lipoprotein cholesterol (LDL-C) levels despite maximally tolerated statin therapy and those with familial hypercholesterolemia.^1,2 The retail cost for these PCSK9i can be as much as $14 000 per year, leading health insurers and pharmacy benefit managers (PBMs) to implement utilization management processes including prior authorization and patient therapy copays. To date, limited empirical information is available on how these preauthorization processes and copays jointly are associated with access to PCSK9i in community practice.