UnitedHealthcare updated its policy after reviewing new guidelines issued by the American College of Cardiology and the American Association of Clinical Endocrinologists and information provided by the Family Heart Foundation, who presented data from their 40 clinical site CASCADE FH® Registry. the Family Heart Foundation is working with multiple health plans and policy makers as part of its FH Can’t Wait campaign, which highlights the significant health risks individuals with FH face due to under-diagnosis and under-treatment.
“This is a great milestone in helping individuals with FH get the treatment they need to lower their cholesterol. We applaud UnitedHealthcare as this decision simplifies access for this largely invisible and misunderstood condition,” said Cat Davis Ahmed, vice president of policy and outreach for the Family Heart Foundation. “the Family Heart Foundation will continue to advocate on behalf of the 1.3 million Americans who have FH and will work together with insurers and policy makers on ways we can make appropriate treatments affordable and accessible for high-risk FH individuals.”Prior authorization is an important step that assesses a number of criteria to identify patients who are appropriate candidates for the therapies, including personal and family medical history, previous use of statins and confirmation of benefits eligibility. By incorporating the newest clinical evidence into coverage criteria and making it easier to demonstrate the diagnosis of FH and previous intolerance to statins, UnitedHealthcare has greatly streamlined the prior authorization process and access to PCSK9 inhibitors for those who qualify to ensure treatment is provided to individuals for whom it is most indicated.
PCSK9 inhibitors are novel drug therapies that have been shown to lower LDL-C by 50-60% or more than can be achieved by statin therapy alone. They work by targeting and inactivating a specific enzyme (called proprotein convertase subtilisin/kexin type 9) thereby increasing the body’s ability to clear LDL-cholesterol from the bloodstream. Recent clinical trial results have shown that PCSK9 inhibitors reduce the risk for cardiac events as well as all-cause mortality.
