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The newly approved PCSK9 inhibitors are a major advance in cholesterol-lowering drug therapy.  Gregory Curfman, MD and Editor in Chief of Harvard Health Publications, has said that this advanced therapy may just rewrite the script for treating patients with chronic high cholesterol.

However, this same therapy promises to further raise the stakes in the ongoing match of manufacturer-payer tug-of-war.

Originally priced at $1,000 per month, manufacturers are seeking top dollar for this therapy to ensure they recoup research and development spending. Payers want to keep spending low and demand evidence-based value.

And the patient?  Stuck in the middle.  Again.

In response to the initial pricing debate, the Institute for Clinical and Economic Review (ICER) has estimated a cost-effective price of PCSK9 inhibitors to be about $2,100 per year. This new figure is nearly 7 times less than the manufacturer’s list price.

We believe it is possible to smooth the path smoothing the path to patient access and payer approval through a process incorporating more elements of value-based pricing.  Where to start?  By incorporating the following three criteria into value-based pricing models:

  • Establishing baseline lab data
  • Assuring adherence (with metrics)
  • Tracking instances of acute care

It is also important to partner with a medication management organization that can provide trial-like conditions for patients, along with best-in-class MTM protocols to ensure value for manufacturers, payers and patients.

Want to know more?  Be sure to read our latest article on this topic, PSCK9 Inhibitors: Smoothing the Path to Access and Value, in Specialty Pharmacy Times.

If you would like to continue the conversation on the importance of value-based pricing in ensuring patient medication access, reach out to Marc O’Connor, Curant Health COO.