A Survey of Noninterventional Cardiologists, Endocrinologists, and Managed Care Organization Pharmacy and Medical Directors

The primary goal of therapy for individuals with dyslipidemia is to improve lipid levels with the overarching aim of preventing cardiovascular (CV) events; abnormal lipid levels are associated with increased risk for atherosclerotic CV disease. Statins are the mainstay of medical treatment for patients with dyslipidemia, and they have been shown to improve CV outcomes. On the other hand, few of the current non-statin lipid-modifying agents have good evidence of such benefits. Two novel cases of lipid-modifying agents with the potential to deliver reductions in CV risk are set to enter the market over the next few years. The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, including Amgen’s evolocumab (Repatha), Sanofi and Regeneron Pharmaceuticals' alirocumab (Praluent), and Pfizer’s bococizumab, have demonstrated excellent LDL-C-lowering efficacy, and early post hoc data suggest CV benefits. The cholesteryl ester transfer protein (CETP) inhibitors—Merck’s anacetrapib and Eli Lilly’s evacetrapib (both of which have shown good efficacy in more than one lipid abnormality)—are oral once-daily medications that are expected to be priced much lower than the injectable PCSK9 inhibitors.

Questions Answered in This Report:

  • Obtain physician perspectives on current and future management of dyslipidemia. How do cardiologists and endocrinologists incorporate the currently available lipid-modifying agents into their treatment algorithms? Where do they see the PCSK9 inhibitors and CETP inhibitors fitting into their practice? Which of the classes holds more promise for physicians and why?

  • Evidence of clinical cardiovascular benefits is becoming increasingly influential for physicians and payers, as well as regulators. How will evidence of CV outcomes benefits alter prescribing of the PCSK9 inhibitors? Will this affect patient share? Will it have an impact on the place of these agents in the treatment algorithm?

  • Understand how payers view and value the novel lipid-modifying agents. The PCSK9 inhibitors are expected to be considerably more expensive than alternative therapies, including the CETP inhibitors. How, and to what extent, will cost of the emerging therapies prevent access to these treatments in an increasingly price-sensitive market? Which of the classes holds more promise for payers and why?

Scope:

The Decision Resources U.S. Physician & Payer Forum report “U.S. Physician and Payer Receptivity to Novel PCSK9 Inhibitors and Other Novel Antidyslipidemic Therapies for Reducing Cardiovascular Risk” examines the reimbursement and treatment decisions that affect prescribing of and access to branded lipid-modifying agents used to treat dyslipidemia and reduce CV risk. We also assess the attitudes and perceptions of the surveyed health professionals regarding two novel non-statin classes: the PCSK9 inhibitors and the CETP inhibitors. This report draws on insights from 100 specialist physicians, including 63 noninterventional cardiologists and 38 endocrinologists, as well as 30 MCO pharmacy and medical directors.

Author(s): Tim Blackstock, M.B., Ch.B., M.Phil.

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