The eternal struggle of finding a treatment that works for you is a complex and infuriating process (as evidenced by a Managed Health Executive article).
Not everyone’s body responds to the active ingredients in medication the same way, so it’s important to have multiple treatment options. Unfortunately, doctors don’t know what will work for which person until it does. Doctors may have to try numerous treatments before they discover which works for you.
Sadly, insurance companies get involved, too. Frequently, they require doctors to exhaust lower cost drug therapies before they will approve the pricey alternative. But that is not the only barrier that stands in the way of prescriptions for certain drugs.
An example can be seen in the atherosclerotic cardiovascular disease (ACD) and familial hypercholesterolemia (FH) communities, who face some of these obstacles while trying to get PCSK9 inhibitors.
A group of researchers tried to find out what exactly was causing these PCSK9 inhibitors to not be prescribed as frequently to patients, including those with ACD and FH. They decided to go to the source—healthcare professionals. They put together a 170-question survey available online to determine the causes. Nearly 450 healthcare workers voluntarily responded to the survey, most of whom have experience in the cardiovascular field.
These healthcare professionals work with people suffering from atherosclerotic cardiovascular disease, who experience a buildup of plaque in the arteries. This buildup hardens and narrows the arteries resulting in a limited flow of blood and oxygen throughout the body.
These healthcare professionals also treat those with familial hypercholesterolemia, who have a genetic predisposition to produce extra cholesterol, which also results in a buildup of plaque and a hardening of arteries. It is one of the leading causes of premature coronary disease and early heart attacks.
PCSK9 inhibitors are a type of biologic drug that deactivates the liver’s ability to produce proprotein convertase subtilisin kexin 9 (PCSK9). With less PCSK9 in the system, the body can process cholesterol more effectively. PCSK9 inhibitors are particularly useful for people who cannot control their cholesterol with diet or other medications because it aids the body in its natural function of processing cholesterol.
From the survey, researchers found that there is blame on multiple sides of this issue. Doctors are not recording or following procedures for recording the levels of certain data. The insurance companies have rejected people who fit every requirement they have set, which causes doctor’s offices to devote time and effort to get more people approved.
Using the data collected from the survey, it may be possible to streamline the approval process.
Click here to read an article that details the survey’s conclusions in more detail.
