Degree Type
Open Access Capstone
Publication Date
Fall 2025
Abstract
Breaking Down the Barriers to PCSK9 inhibitors
Abstract
Treating high cholesterol with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are an important part of risk reduction for coronary artery disease (CAD) (Baum et al., 2017). Patients are going without needed treatment with PCSK9 inhibitors due to barriers related to Prior Authorization (PA), including the unusually high denial rate for this medication class, in fact, based on insurance datasets it is estimated that 4 out of 5 PAs for PCSK9 inhibitors are denied on the first try (Nasir, Angraal & Virani, 2019). Despite a novel tactic by the manufacturer of dropping the price of Repatha in March of 2018, cost still remains a barrier in addition to the needlestick and prior authorization (Smith et al., 2021). One specific problem is the lack of knowledge on what to order for genetic testing for familial hyperlipidemia (FH), which can result in a lack of necessary data to fill out the PA form properly (Graham, 2017). The proposed solution is to train providers by designing and implementing a CEU training about proper documentation and genetic testing for familial hyperlipidemia (FH). Administering a questionnaire before and after the training will assess success and gain information to help determine what further research is needed to break down the barriers of treatment with PCSK9 inhibitors. System level changes in prior authorization are desperately needed, by means of legislative changes to overhaul the inefficient system that is currently in place. Thankfully bills outlining prior authorization reform are already in process in some states (H.B. 1136, 2025).
Recommended Citation
Perna, Crystal D., "Breaking Down the Barriers To PCSK9 Inhibitors" (2025). Nursing (MS) Capstones Collection. 9.
https://scholarworks.umb.edu/nursing_capstone/9