Date of Award

2018

Document Type

Dissertation

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Lynne Braun

Third Advisor

Kim Allan Williams, Sr.

Fourth Advisor

James S Zoller

Abstract

PURPOSE: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have shown superb efficacy in lowing LDL-C for patients who are not controlled by or are intolerant of first line medications such as high intensity statins and ezetimibe. Yet because of their high yearly cost of over $14,000 along with life-long cumulative costs, insurance payers have created strict guidelines to control utilization. This is an important area of research because there are no large retrospective studies that have examined the differences in utilization uptake of PCSK9 inhibitors among the major payer categories. The purpose of this study is to establish whether insurance coverage payer type affects the rate of utilization uptake of PCSK9 inhibitors. METHODS: Prescription billing data for PCSK9 inhibitor for commercially insured patients, Medicare beneficiaries with supplemental insurance, and Medicaid patients were extracted from Truven Health Analytics MarketScan® data for 2015. A patient cohort defined by atorvastatin 80 mg or rosuvastatin 40 mg utilization (maximum dose high intensity statins) served as the denominator population for uptake rate calculations. Data were limited to the first 6-months post FDA approval of PCSK9 inhibitors. PCSK9 inhibitor uptake rates were estimated using simple projection and regression modeling. Out-of-pocket costs were estimated by insurance type. RESULTS: The results of the claims ratio analysis indicate that the three insurance payer cohorts had significantly different uptake ratios (P<0.0001) at six months. Initially, the Private insurance cohort had a faster uptake ratio, but the Medicare cohort ratio surpassed the Private insurance growth rate by the end of the study. Furthermore, the two forecasting growth curves (percent increase and ordinary least squares regression) indicate that Medicare has the greater anticipated future uptake utilization when compared to the Private insurance payer. Using regression modeling, the uptake slope showed a trend towards greater uptake for Medicare compared with commercially insured subjects (p=0.0772). Importantly, PCSK9 inhibitor uptake for the Medicaid cohort was much smaller compared to the commercially insured and Medicare cohorts. CONCLUSION: The analysis of PCSK9 inhibitor claims during the first 6 months post FDA approval revealed a slightly faster uptake trend in Medicare patients compared with patients with commercial insurance, with uptake for Medicaid patient being much lower. The results indicate that barriers to access to PCSK9 inhibitors may vary by insurance. Future studies should examine if barriers are associated with: 1) stricter approval guidelines to manage PCSK9 inhibitor utilization by some insurers; or 2) disparities in prescribing rates associated with insurance type.

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