Press Release

***PRESS RELEASE*** Statement from Cardiovascular Patient Advocates on Troubling ICER Report on PCSK9 Inhibitors

STATEMENT FROM KEITH FERDINAND, MD, CARDIOLOGIST:

“ICER’s report is a disappointment for patients and physicians and other practitioners who have seen expected results with these drugs. For patients suffering with extremely high cholesterol, these medications can reduce the risk of heart attack and stroke. Unfortunately, ICER’s report could jeopardize many patient’s ability to access the life-saving medication they and their physicians and other providers have determined is the best course of care.”

***PRESS RELEASE*** Cardiovascular Health Forum to Highlight Access Barriers to Groundbreaking, Cholesterol-Lowering Therapies

Florida health plans reject nearly 50 percent of claims for treatment

WASHINGTON – On Saturday, August 5, the Partnership to Advance Cardiovascular Health will host a health forum, “Advancing Cardiovascular Health & Patient Access to Innovative Therapies.” The lunchtime event in Orlando at the Florida Medical Association’s annual meeting will bring together patient advocates, clinicians, and policymakers to discuss innovations in cardiovascular therapies, high rates of cardiovascular disease in Florida and barriers that patients face in accessing new cholesterol-lowering drugs. Seth Baum, MD, founder of Excel Medical Clinical Trials and president of the American Society for Preventive Cardiology, will lead the forum.

***PRESS RELEASE*** Cardiovascular Health Advocates to Launch Change.org Petition to National Association of Insurance Commissioners Regarding Access to Cholesterol-Lowering Therapies

Petition launch coincides with cardiovascular health forum in Alabama.

WASHINGTON – On Friday, June 23, the Partnership to Advance Cardiovascular Health (PACH) will launch a petition on Change.org directed at the National Association of Insurance Commissioners in response to the alarming rejection rates that qualifying patients across the country face in accessing new, groundbreaking, cholesterol-lowering medications known as PCSK9 inhibitors. The petition will be promoted at a series of health forums on the status of cardiovascular health in states where there is an enhanced need for access to cholesterol-lowering therapies but health plan barriers remain high. Many health plans around the country are using restrictive plan designs and utilization management tools to force patients onto less effective therapies in spite of physicians’ recommendations and compelling data.

***PRESS RELEASE*** Cardiovascular Health Forum to Highlight Access Issues to Groundbreaking, Cholesterol-Lowering Therapies; Launch National Petition for Greater Access

Alabama has the second highest death rate from cardiovascular disease in the country yet state health plans reject more than 50 percent of claims for treatment

WASHINGTON – On Friday, June 23, the Partnership to Advance Cardiovascular Health, along with Mended Hearts, will host “The Status of Cardiovascular Health in Alabama: A Forum.” The lunchtime event in Birmingham will bring together patient advocates, clinicians and policymakers to discuss innovations in cardiovascular therapies, high rates of cardiovascular disease in Alabama and barriers that patients face in accessing new cholesterol-lowering drugs. In an Alabama Health Plan Coverage Report Card from the Institute for Patient Access, data shows Alabama health plans reject more than 50 percent of claims for PCSK9 inhibitors.

RELEASE: New PACH Video Highlights Patient Stories of PCSK9 Inhibitor Barriers

New Video “PCSK9 Inhibitors: Access Barriers Affect Real People” Highlights Barriers to New, Breakthrough Cholesterol-Lowering Drugs

 WASHINGTON – Today the Partnership to Advance Cardiovascular Health released a new web video, “PCSK9 Inhibitors: Access Barriers Affect Real People.” The video, featuring patient testimonials, explores access issues to new, breakthrough cholesterol-lowering drugs known as PCSK9 inhibitors. 

***PRESS RELEASE*** South Carolina Health Plans Reject Over Half of Claims for High Cholesterol Treatment

***PRESS RELEASE*** South Carolina Health Plans Reject Over Half of Claims for High Cholesterol Treatment

New health plan report card analyzes PCSK9 inhibitor claims for managed care organizations

 WASHINGTON – The Institute for Patient Access released a new Health Plan Coverage Report Card highlighting the rates at which South Carolina insurers deny patients coverage for advanced cholesterol-lowering drugs known as PCSK9 inhibitors. The report card reveals that health plans reject nearly 50 percent of claims submitted for coverage of prescribed PCSK9 inhibitors. The data, collected from August 2015 to July 2016 by a national data supplier, reflects PCSK9 inhibitor claims for South Carolina managed care organizations, including commercial plans, Medicare and managed Medicaid.

***PRESS RELEASE*** Texas Health Plans Reject Nearly Half of Claims for High Cholesterol Treatment

New health plan report card analyzes PCSK9 inhibitor claims for managed care organizations

 WASHINGTON – The Institute for Patient Access released a new Health Plan Coverage Report Card highlighting the rates at which Texas insurers deny patients coverage for advanced cholesterol-lowering drugs known as PCSK9 inhibitors. The report card reveals that health plans reject nearly one out of every two claims submitted for coverage of prescribed PCSK9 inhibitors. The data, collected from July 2015 to July 2016 by a national data supplier, reflects PCSK9 inhibitor claims for Texas managed care organizations, including commercial plans, Medicare and managed Medicaid.

Key Texas Findings:

  • 46% average rejection rate
  • 2,877 total rejections
  • 745 appeals
  • Highest rates of rejection: Federal Employee Benefit Plan (91%), Express Scripts (73%), Teacher Retirement System of Texas TRS (64%)
  • Lowest rates of rejection: Humana Health Plan (31%), Tricare Military Health SVC SYS (31%), Aetna US Healthcare (28%)

 

“This is a very troubling and frankly dangerous finding,” said Alliance for Patient Access Executive Director Brian Kennedy. “The patients prescribed this medicine have extremely high LDL cholesterol, and statins alone are not sufficient to reduce their risk of heart attack. With these new cholesterol-lowering drugs, patients’ risk of heart attack decreases, yet insurance companies are too often refusing to cover the medicine.”

PCSK9 inhibitors work by extending the lifespan of a receptor on the liver that clears “bad” cholesterol.  Clinical trials data show that PCSK9 inhibitors can lower LDL cholesterol more than statins alone and can also reduce the associated risks of heart attack and stroke.

The Institute for Patient Access report card highlights the 13 Texas health plans that process the most PCSK9 inhibitor claims, ranking them based on the number of rejections issued. The least patient-friendly plans were the Federal Employee Benefit Plan, with a rejection rate of 91%, and Express Scripts at 73%. Also denying claims at a far higher rate than the state average were Teacher Retirement System of Texas TRS, 64%, and Wellcare Management Group, 61%. Humana Health Plan, Tricare Military Health SVC SYS and Aetna had the lowest rejection rates, though they still denied roughly 30% of claims.

This report card is one in a series to be released by the Institute for Patient Access in 2017 to highlight barriers to patient access.

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BACKGROUND

Institute for Patient Access

PCSK9 Inhibitors Texas Report Card

Alliance for Patient Access

***PRESS RELEASE*** Florida Health Plans Reject Nearly Half of Claims for High Cholesterol Treatment

New health plan report card analyzes PCSK9 inhibitor claims for managed care organizations.

WASHINGTON – The Institute for Patient Access today released a new Health Plan Coverage Report Card highlighting the rates at which Florida insurers deny patients coverage for advanced cholesterol-lowering drugs known as PCSK9 inhibitors. The report card reveals that health plans reject nearly one out of every two claims submitted for coverage of prescribed PCSK9 inhibitors. The data, collected from August 2015 to July 2016 by a national data supplier, reflects PCSK9 inhibitor claims for Florida managed care organizations, including commercial plans, Medicare and managed Medicaid.

Key Florida Findings:

  • 45% average rejection rate
  • 3,784 total rejections
  • 1,197 appeals
  • Highest rates of rejection: Federal Employee Benefit Plan (77%), Express Scripts (76%), Cigna Healthcare (63%)
  • Lowest rates of rejection: Aetna US Healthcare (29%), Freedom Health FL (29%), Humana Health Plan (29%)

 

“This is a very troubling and frankly dangerous finding,” said Alliance for Patient Access Executive Director Brian Kennedy. “The patients prescribed this medicine have extremely high LDL cholesterol, and statins alone are not sufficient to reduce their risk of heart attack. With these new cholesterol-lowering drugs, patients’ risk of heart attack decreases, yet insurance companies are too often refusing to cover the medicine.”

PCSK9 inhibitors work by extending the lifespan of a receptor on the liver that clears “bad” cholesterol.  Clinical trials data show that PCSK9 inhibitors can lower LDL cholesterol more than statins alone and can also reduce the associated risks of heart attack and stroke.

The Institute for Patient Access report card highlights the 15 Florida health plans that process the most PCSK9 inhibitor claims, ranking them based on the number of rejections issued. The least patient-friendly plans were the Federal Employee Benefit Plan, with a rejection rate of 77%, and Express Scripts at 76%. Also denying claims at a far higher rate than the state average were Cigna Healthcare, 63%, and Florida Blue, 61%. Humana Health Plan, Aetna and Freedom Health Florida denied fewer than 30% of claims.

This is the first in a series of state report cards that the Institute for Patient Access will release in 2017 to highlight barriers to access.