Implementation of a New Clinic-Based, Pharmacist-Managed PCSK9 Inhibitor Consultation Service

Atanda, Adenike; Shapiro, Nancy L.; Stubbings, Jo Ann; Groo, Vicki L.

doi:10.18553/jmcp.2017.23.9.918

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…This was not surprising given that the mean baseline level of medication adherence for PCSK9is was high (>80%) and that the likelihood of receiving the full HCV drug regimen with the original NDC medication was also high (>90%), indicating limited scope for improvement. These high rates of adherence to therapy and complete treatment are often achieved through intentional clinical management programs that monitor patients’ treatment and adherence [ 43 , 44 ]. Despite seeing a lack of overall change in adherence to treatment, changes in adherence may be different across subgroups, such as those with a high comorbidity burden, [ 45 ] although additional research is warranted to assess this.…”

Section: Discussionmentioning

confidence: 99%

Impact of list price changes on out-of-pocket costs and adherence in four high-rebate specialty drugs

Wong¹,

Seetasith²,

Hung

et al. 2023

PLoS ONE

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Background Insurers manage the cost of specialty medicines via rebates, however it is unclear if the savings are passed on to patients, and whether reducing rebates may lead to changes in patient out-of-pocket (OOP) costs and medication adherence. This study examined two drug classes to understand the impact of reducing list prices to net prices, via lower-priced national drug codes (NDCs) or authorized generics, on patient OOP costs and adherence. Methods This retrospective analysis assessed IQVIA PharMetrics ® Plus adjudicated medical and pharmacy claims for commercially insured patients. Patient OOP costs per prescription and payer drug costs were assessed for evolocumab or alirocumab (proprotein convertase subtilisin/kexin type 9 inhibitors [PCSK9is]) or velpatasvir/sofosbuvir or ledipasvir/sofosbuvir (hepatitis C virus [HCV] medications). For PCSK9is and HCV medications, the original and lower-priced versions were compared. Adherence was estimated based on proportion of days covered (PDC) (PCSK9is) and receipt of full treatment regimen (HCV medications). Results In total, 10,640 patients were included (evolocumab, 5,042; alirocumab, 1,438; velpatasvir/sofosbuvir, 2,952; ledipasvir/sofosbuvir,1,208). After list price reductions, mean payer drug costs decreased by over 60%, while patient OOP cost reductions ranged from 14% to 55% (evolocumab: 55%, p < 0.01; alirocumab: 51%, p < 0.01; velpatasvir/sofosbuvir: 30%, p < 0.01; ledipasvir/sofosbuvir: 14%, p = 0.03). Patients with coinsurance as the largest contributor to their OOP costs had the largest reductions in OOP costs, ranging from adjusted, mean values of US$135 to US$379 (>60% reductions). Six-month PDC for PCSK9is and proportion receiving full HCV treatment regimen were high with the original versions and did not substantially differ with the new, lower-priced versions. Conclusions Reducing list prices to approximate net prices (as a proxy for reducing rebates) resulted in lower patient OOP costs, particularly for those with coinsurance. Our findings suggest that future reduction of rebates may assist in patient affordability, although additional transparency is needed.

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Section: Discussionmentioning

confidence: 99%

Impact of list price changes on out-of-pocket costs and adherence in four high-rebate specialty drugs

Wong¹,

Seetasith²,

Hung

et al. 2023

PLoS ONE

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“…Importantly, the pharmacist-led model frees up time in cardiology and lipidology clinics, creating greater outpatient capacity. Pharmacist-led PCSK9i provision has previously been successfully implemented at centres in the USA 24 25. The focus of these US pharmacy models was on screening for eligibility, recommending alternative lipid-lowering therapies for ineligible patients, facilitating insurance claims and delivery of PCSK9i supply.…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacist-led PCSK9i provision has previously been successfully implemented at centres in the USA. 24 25 The focus of these US pharmacy models was on screening for eligibility, recommending alternative lipid-lowering therapies for ineligible patients, facilitating insurance claims and delivery of PCSK9i supply. In our model, pharmacists reviewed patients in clinic, prescribed PCSK9i and other lipid-lowering therapies, monitored for safety and efficacy, and closely followed up patients to address concerns, support adherence and further optimise lipid-lowering therapy where needed; treatment response and patient satisfaction with the service were formally evaluated.…”

Section: Discussionmentioning

confidence: 99%

Innovative, centralised, multidisciplinary medicines optimisation clinic for PCSK9 inhibitors

et al. 2022

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BackgroundProprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9is) are an important but underutilised option to help optimise lipid management. We developed a new service to improve patient access to these medicines in line with National Institute for Health and Care Excellence recommendations. This paper describes the model and provides lipid-lowering results and feedback from the first 100 referred patients.MethodsThe service is based on a centralised multidisciplinary clinic that is the sole prescriber of PCSK9i therapy in the area. Referred patients are assessed for eligibility and given tailored, person-centred support, education and monitoring to promote treatment adherence and lipids optimisation. The clinic also supports referred patients that do not meet PCSK9i eligibility criteria.ResultsAmong the first 100 patients referred (n=62 male; mean age: 62.9±10.5 years), 48 were initiated on PCSK9i therapy. Mean total cholesterol decreased from 7.7±1.6 mmol/L at baseline to 4.5±1.4 mmol/L at 3 months (41% reduction), while mean low-density lipoprotein-cholesterol (LDL-C) fell from 5.0±1.6 mmol/L to 2.1±1.3 mmol/L (58% reduction; p<0.0001) and median LDL-C decreased from 4.8 mmol/L to 1.6 mmol/L (67% reduction) over the same period. These decreases were maintained at 12 months (45%, 65% and 67% reductions, respectively; p<0.0001 for the decrease in mean LDL-C from baseline). Patient feedback on the clinic was positive and overall satisfaction was high.ConclusionsThis innovative, person-centred, multidisciplinary service successfully initiated PCSK9i therapy for eligible patients and drove long-term monitoring, adherence and cholesterol lowering. It also provided medicines optimisation and adherence assistance to PCSK9i-ineligible patients. The model could be used in other areas to support better uptake and optimisation of PCSK9i therapy.

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The comparative effects of high dose atorvastatin and proprotein convertase subtilisin/kexin type 9 inhibitor on the mitochondria of oxidative muscle fibers in obese-insulin resistant female rats

Thonusin¹,

Apaijai²,

Jaiwongkam³

et al. 2019

Toxicology and Applied Pharmacology

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Implementation of a New Clinic-Based, Pharmacist-Managed PCSK9 Inhibitor Consultation Service

Cited by 6 publications

References 17 publications

Impact of list price changes on out-of-pocket costs and adherence in four high-rebate specialty drugs

Impact of list price changes on out-of-pocket costs and adherence in four high-rebate specialty drugs

Innovative, centralised, multidisciplinary medicines optimisation clinic for PCSK9 inhibitors

The comparative effects of high dose atorvastatin and proprotein convertase subtilisin/kexin type 9 inhibitor on the mitochondria of oxidative muscle fibers in obese-insulin resistant female rats

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