Pharmacy benefit manager CVS urges rewrite for U.S. heart guidelines

http://www.reuters.com/article/2015/08/10/us-health-cholesterol-cvs-idUSKCN0QF1RY20150810

High cholesterol is nothing to screw around with.. this new drug is specifically for pts who have failed all other therapies to lower their cholesterol levels.  Is CVS and other PBM (Prescription Benefit Managers) practicing medicine based solely as financial/economic reasons..  Are we heading down the path of putting a “PRICE ON A LIFE”. There are only three PBM’s that control the majority of the PBM marketplace. If proposed mergers go thru we will have three insurance companies controlling the majority of the marketplace and we have four chain pharmacies that control a majority of that marketplace. Less than a total of 10 FOR PROFIT companies with TOO MUCH influence over our healthcare ?

CVS Health Corp, the second largest manager of drug benefit plans for U.S. employers and insurers, asked heart specialists on Monday to revamp guidelines for treating patients with high cholesterol after the launch of new, expensive medications.

The unusual move is the latest salvo in the war on escalating U.S. healthcare costs, with insurers using aggressive tactics to extract steep price discounts from drugmakers, even for the newest medications, and controlling patient access to the most expensive drugs.

CVS wrote a letter published in the latest edition of the Journal of the American Medical Association saying current guidelines, which include a formula for assessing heart disease risk rather than specific targets for levels of “bad” LDL cholesterol, do not provide clarity on how to choose the best, and most cost effective, therapy.

CVS says LDL targets are needed now that the U.S. Food and Drug Administration has approved Regeneron Pharmaceuticals Inc and Sanofi SA’s Praluent, a potent new drug which works by blocking a protein called PCSK9 that helps LDL cholesterol stay in the bloodstream. An FDA decision on a second PCSK9 inhibitor, Amgen Inc’s Repatha, is expected later this month.

CVS and other pharmacy benefit managers are concerned about the cost of the PCSK9s compared to older cholesterol fighters such as statins, which are available as generics for less than $50 a month. Praluent, given by injection, has a list price of almost $15,000 a year. [L1N10L02N]

Both Praluent and Repatha, in combination with statins, have been shown to lower cholesterol by around 60 percent compared to statins alone.

“The current cholesterol management guidelines do not provide clarity as to how these expensive new medications could fit in the treatment paradigm, potentially resulting in some scenarios where a prescriber could consider a PCSK9 inhibitor for a low-risk patient,” Dr. William Shrank, chief scientific officer at CVS, said in a statement.

The latest treatment guidelines, issued in 2013 by the American College of Cardiology and the American Heart Association, overturned decades of practice in which doctors screened patients for high cholesterol, then sought to reduce LDL to a specific level.

Dr. Troyen Brennan, CVS chief medical officer, said that if the guidelines are not changed, CVS will use its own targets, which will vary depending on patient history. “We expect patients to first use statins,” he said. “If they can’t use statins, or can’t make (LDL) targets, then they would use PCSK9 inhibitors.”

Some prominent cardiologists have questioned the 2013 guidelines, but the ACC and AHA have shown little appetite to return to LDL targets. “LDL may or may not correlate to cardiovascular outcomes,” Dr. Kim Allan Williams, president of the ACC, told Reuters last week.

CVS estimates that about 73 million Americans have elevated cholesterol.

“PCSK9 inhibitors will be used chronically — generally for the remainder of the lives of treated patients,” CVS said in its letter. “As a result, most payers, both government and commercial, are probably considering thoughtful ways to rationalize the use of these medications.”

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