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Research Letter
September 13, 2017

Nationwide Coverage and Cost-Sharing for PCSK9 Inhibitors Among Medicare Part D Plans

Author Affiliations
  • 1Division of Cardiology at Zuckerberg San Francisco General Hospital, University of California, San Francisco
  • 2Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
  • 3Harvard Pilgrim Health Care Institute, Boston, Massachusetts
  • 4Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
  • 5Pacific Health Research and Education Institute, Honolulu, Hawaii
  • 6Department of Family Medicine and Community Health, University of Hawaii John A. Burns School of Medicine, Honolulu
JAMA Cardiol. Published online September 13, 2017. doi:10.1001/jamacardio.2017.3051

Approximately 9 million US adults with atherosclerotic cardiovascular disease or familial hypercholesterolemia do not achieve optimal levels of low-density lipoprotein cholesterol despite maximally tolerated statin therapy.1 Adding a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) may significantly lower low-density lipoprotein cholesterol levels and reduce the risk of myocardial infarction and stroke.2 However, PCSK9is are expensive, with annual costs exceeding $14 500.1 Understanding patients’ share of drug costs is important because high out-of-pocket costs can adversely affect affordability and adherence to lifelong treatment.3 Because 1 in 4 Medicare beneficiaries has ischemic heart disease and nearly 1 in 2 has hyperlipidemia,4 we examined PCSK9i cost-sharing requirements for Medicare Part D plans nationwide, which insure 41 million beneficiaries.5

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