Tying Reimbursement to Outcomes Is an Ideal Strategy for PCSK9 Inhibitors

Abstract

This Viewpoint promotes using outcomes-based pricing strategies for proprotein convertase subtilisin/kexin type 9 inhibitors.

Predictors of PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) Inhibitor Prescriptions for Secondary Prevention of Clinical Atherosclerotic Cardiovascular Disease

“…[9][10][11][12] Potential explanations for this slow uptake include PCSK9 inhibitors' high initial cost ($14 000 per year) and lack of cost-effectiveness at this price, leading payers to impose prior authorization and cost-sharing requirements; the lack of evidence from early randomized trials that PCSK9i improve mortality, and that new therapies often take many years to diffuse into clinical practice. 8,[13][14][15][16][17][18][19] In response to these cost-effectiveness concerns, Amgen and Sanofi-Regeneron reduced prices for evolocumab and alirocumab to $5850/y. These price cuts were instituted in November, 2018 for evolocumab, and March, 2019 for alirocumab.…”

Cost-effectiveness of PCSK9 Inhibitors

“…In addition, recalibrated cost-effectiveness models that separately weigh disease-specific states and quality of life might yield more favorable results than the current models, but are likely to still fall short for these particular agents. Novel pricing strategies for new expensive therapies, such as outcomes-based pricing, are worthy of serious investigation. Additional economic issues currently limit access to PSCK9 inhibitors, including variations in individual out-of-pocket expenses and the opaque role of pharmacy benefits managers .…”