Heart of Health Policy | National Drug Codes Impacting PCSK9 Pricing For Patients

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While 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, patients continue to report difficulties obtaining treatment at the lowered cost.

ACC research into this trend has revealed pricing variances between pharmacies using original National Drug Codes (NDCs) for PCSK9 inhibitors that are tied to higher pricing and those using new NDCs that reflect the lower pricing.

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 NDCs. Patients should also consider "shopping around" for the lowest price, as local pharmacies may be able to fulfill these prescriptions at more competitive costs. Several new mobile apps allow consumers to compare pricing across pharmacies.

Clinical Topics: Dyslipidemia, Lipid Metabolism, Nonstatins, Novel Agents

Keywords: ACC Publications, Cardiology Magazine, Health Policy, Health Expenditures, Pharmacies, Mobile Applications, Insurance Coverage, Pharmacy, Proprotein Convertases, Pharmaceutical Services, Medicare, Cholesterol


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