A new class of injectable medications will soon be available for use in treating high cholesterol. These drugs are called PCSK9 inhibitors, and they’re currently still in development by a variety of pharmaceutical companies. Approvals are expected midyear.
While news of medication that can potentially reduce levels of bad cholesterol (LDL) in people who otherwise are unable to lower their level is welcome, the high price tag is not. According to an article on Bloomberg.com, the drugs may cost anywhere from $7,000 to $12,000 per year.
This may seem low when compared to recently approved hepatitis C medications, at $84,000 or more per treatment, but it’s not. When a hepatitis C patient is given a course of treatment, in most cases the disease is cured. So while the cost of treatment is high, it’s a one-time cost.
In the case of these new injectable cholesterol mediations, treatment may be required for the rest of the individual’s life. Clearly this kind of cost is likely to create significant financial strain on our healthcare system – and particularly on employers, who bear a significant portion of healthcare costs on behalf of their employees. In fact, according to a spokesperson from CVS, as quoted in a Business Insurance article, these new drugs could end up costing the U.S. healthcare system as much as $150 billion per year, making it the highest-selling class of drugs in history.
We’ll Help You Plan and Manage These Costs
At Lockton, we’re paying close attention to new specialty drugs as they’re on their way to approval. Using our own data analytics tools, we can see diagnosis codes related to an employee population and provide our clients with a reasonable range of cost increases they might experience so they can prepare.
In the case of these new injectable PCSK9 inhibitors, we’re already helping our clients predict how many of their members might switch to one of the new drugs, based on those who are currently using an ordinary, inexpensive statin. Then we can predict the cost.
Here’s an example: ABC Company currently has 1,060 employees who are taking a statin. Let’s say 20 percent of these individuals (that’s 212 people) are unable to reduce their LDL cholesterol so they switch to one of the new injectable options. Assuming the new medications are approved midyear, ABC Company could reasonably expect to spend an additional $1.25 million in 2015 for this drug alone. (You can figure that cost might double the next year, when members take it for a full calendar year.)
Some pharmacy benefit managers (PBMs) are already putting pressure on drug companies to lower their high price tags when it comes to hepatitis C treatments. Similarly, CVS and Express Scripts are also stating their intent to push back on the manufacturers of these new cholesterol-lowering medications regarding price.
So while we’re helping our clients predict their potential costs even in advance of drug approval, we’re also paying close attention to the PBMs to see how they will decide to manage utilization of these drugs through prior authorizations and step therapy.