Dyslipidemia | Access & Reimbursement | US | 2021
Dyslipidemia is an important modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD), a leading causes of death globally. Statins continue to dominate treatment for dyslipidemia, driven largely by strong physician familiarity with them and their low cost owing to their widespread generics availability. With the positive cardiovascular (CV) outcomes data for certain nonstatin therapies, including PCSK9 inhibitors and Vascepa, we expect the treatment paradigm to evolve. However, the high price of the PCSK9 inhibitors has led to severe access restrictions and, ultimately, new pricing negotiations. Now these drugs face new competition from Nexletol and Nexlizet (Esperion Therapeutics) and the soon to launch inclisiran (Novartis). Questions remain about whether physicians’ and payers’ attitudes toward current and emerging therapies will be swayed more by products’ prices or clinical benefits.
QUESTIONS ANSWERED
- How have payers been reimbursing dyslipidemia brands, such as Amgen’s Repatha and Sanofi / Regeneron’s Praluent, since their prices were reduced in 2019, and what restrictions have they imposed?
- What factors most heavily influence payers’ reimbursement decisions about dyslipidemia drugs?
- What role do reimbursement, restriction, and patient cost play in physicians’ prescribing decisions for dyslipidemia therapies?
- How have payers been reimbursing Esperion’s Nexletol / Nexlizet since ICER’s review, and how will payers reimburse Novartis’s inclisiran postlaunch? What restrictions will they impose?
CONTENT HIGHLIGHTS
Geography: United States.
Primary research: Survey of 50 U.S. cardiologists and 50 U.S. PCPs; survey of 30 U.S. managed care organizations (MCO) pharmacy and medical directors (PDs / MDs).
Key drugs covered: Vascepa, Repatha, Praluent, Nexletol, Nexlizet, Leqvio (inclisiran), and lerodalcibep.
Key analysis provided:
- Reimbursement and contracting.
- Access and prescribing.
- Opportunities and challenges for emerging therapies.
- Disease-specific special topic.
PRODUCT DESCRIPTION
U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.
