Introduction & Agenda

  1. Letter to Participants from Drs. Dharam Kumbhani and Lonny Reisman
  2. Effective Prior Authorization: Right Drug, Right Patient for CV Treatment Roundtable Agenda
  3. Interactive Table Discussion Questions


  1. Barriers to New Medications for Cardiovascular Disease: Insights from CardioSurve (Cardiology 2017)
  2. Cardiologists Perceptions of Access to New Therapies (ACC CardioSurve 2016)
  3. Prior Authorization and Utilization Management Reform Principles (AMA)
  4. ACC Tackling Prior Authorization (JACC – Wilson and Shor 2017)
  5. New Ohio Law to Speed Medical Authorization (The Blade – Provance 2016)
  6. Fight Over Decisions on What Health Insurance Covers Heats Up in Pennsylvania (Lancaster Online – Stauffer 2017)
  7. A Call for Prior Authorization and Utilization Management Reform to Improve Patient Centered Cardiovascular Prevention Care (Journal of Cardiovascular Nursing – Dennison Himmelfarb and Hayman 2017)
  8. Improving Access to Cardiovascular Care, A White Paper from the Physicians Cardiovascular Disease Working Group (Alliance for Patient Access 2016)
  9. New Collaboration Improves Access to Treatment for Familial Hypocholesteremia (FH) Patients Most at Risk for Early Heat Attacks and Death (The FH Foundation 2017)
  10. Access to Nonstatin Lipid-Lowering Therapies in Patients at High Risk of Atherosclerotic Cardiovascular Disease (Circulation – Knowles et al. 2017)
  11. Barriers to PCSK9 Inhibitor Prescriptions for Patients with High Cardiovascular Risk: Results of a Healthcare Provider Survey Conducted by the National Lipid Association (Journal of Clinical Lipidology – Cohen et al. 2017)
  12. PCSK9 Inhibitor Access Barriers- Issues and Recommendations Improving the Access Process for Patients, Clinicians, and Payers (Clinical Cardiology – Baum et al. 2017)
  13. The Effect of Formulary Restrictions on Patient and Payer Outcomes: A Systematic Literature Review (JMCP – Park et al. 2017)

Prior Authorization Forms

  1. Aetna - Repatha
  2. CVS/Caremark - Repatha
  3. Express Scripts - Repatha
  4. OptumRx - Repatha
  5. Cigna - Repatha
  6. Express Scripts - Praluent
  7. Carefirst & CVS/Caremark – Praluent
  8. Carefirst & CVS/Caremark - Entresto
  9. OptumRx - Entresto

Guidelines, Pathways, and Recommendations

  1. 2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non- Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk (JACC – Lloyd-Jones et al. 2017)
  2. Update on the Use of PCSK9 Inhibitors in Adults: Recommendations from an Expert Panel of the National Lipid Association (Journal of Clinical Lipidology – Orringer et al. 2017)
  3. ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure (JACC – Yancy et al. 2017)

Cost Effectiveness

  1. Evolocumab for Treatment of High Cholesterol: Effectiveness and Value (Institute for Clinical and Economic Review 2017)
  2. Updated Cost-Effectiveness Analysis of PCSK9 Inhibitors Based on the Results of the FOURIER Trial (JAMA – Kazi et al. 2017)
  3. Estimation of Eligibility for Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors and Associated Costs Based on the FOURIER Trial (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk). (Circulation – Virani et al. 2017)
  4. Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared with Enalapril for the Treatment of Heart Failure with Reduced Ejection Fraction (JACC – King et al. 2016)

Patient Education

  1. 5 Ways Your Insurer May Prevent You from Getting Your Medicine (
  2. 5 Questions to Ask About Your Prescription Medicine Coverage (
  3. 4 Ways to Better Engage and Empower Patients (
  4. Insurance Basics (


  1. Provider Perspective – Session 1
  2. Patient Perspective – Session 2
  3. Employer Perspective – Session 2
  4. athenahealth EHR PA patterns - Session 3
  5. PINNACLE – Session 3
  6. Surescripts Analytics – Session 3

Other Materials

  1. Statement on Cost-Value Methodology