New Class of Self-Injectable Cholesterol-Lowering Medication (PCSK9 Inhibitors) Currently Excluded under the Plan
PCSK9 interferes with the liver's ability to remove cholesterol from the blood.Evolocumab is a human monoclonal antibody that inhibits or blocks the PCSK9 and is administered via subcutaneous injection once or twice a month depending on the dosage.
PCSK9's are intended for use with patients that have:
- High LDL levels that cannot be adequately lowered with statins
- Familial Hypercholesterolemia (FH), a life-threatening genetic disorder that inhibits the ability to break down artery-blocking low density lipoproteins (LDL)
- Adverse effects from using statins
PCSK9's have proven to be effective in lowering "bad" LDL (low-density lipoprotein) cholesterol when given in combination with standard oral statin therapy.
The Welfare Fund in coordination with its Pharmacy Benefit Manager have agreed to exclude this new class of medication from coverage for 6 months as more is learned about PCSK9's. During this time, more information would be gathered by the industry regarding outcomes and safety of this new class of medications. Protocols and procedures may change in the future as more is learned about PCSK9's.