In the last year, makers of PCSK9 inhibitors have announced significant reductions in the list price of their cholesterol-lowering treatments, dropping the annual cost by 60 percent to $5,850. Following feedback that patients continue to experience difficulties obtaining treatment at the lowered cost, the ACC has found that lower pricing for PCSK9 inhibitors is linked to new National Drug Codes (NDCs), while the original NDCs, which remain in effect, are tied to higher list prices. As a result, pharmacies processing prescriptions for PCSK9 inhibitors using the original NDC may not offer updated pricing options available to some patients.

While clinicians should note that individual out-of-pocket costs will vary based on a patient's insurance coverage and contracted pharmacy rates, the ACC encourages members to discuss appropriate pricing with their patients receiving PCSK9 inhibitors, particularly those covered by Medicare. Additionally, the College suggests working with patients to contact their pharmacies and ask if out-of-pocket costs for PCSK9 inhibitors would be lower under the new NDC code. Patients should also consider "shopping around" for the lowest price, as local pharmacies may be able to fulfill these prescriptions at more competitive costs.

Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Lipid Metabolism, Nonstatins

Keywords: ACC Advocacy, Pharmacies, Health Expenditures, Pharmaceutical Services, Medicare, Insurance Coverage, Cholesterol

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