Table 3.
Medication access, tolerability, and outcomes.
| Variable | Combined Cohort | PCSK9i Cohort |
EPA Cohort | SGLT2i Cohort | GLP-1 RA Cohort |
|---|---|---|---|---|---|
| N | 320 | 93 | 131 | 46 | 50 |
| Taking the medication, N (%) | 243 (75.9) | 87 (93.5) | 87 (66.4) | 34 (73.9) | 35 (70) |
| Reason for not taking, N (%) | |||||
| Cost | 51 (15.9) | 2 (2.2) | 36 (27.5) | 2 (4.3) | 11 (22) |
| Side effects | 15 (4.7) | 2 (2.2) | 6 (4.6) | 4 (8.7) | 3 (6) |
| Patient preference | 9 (2.8) | 2 (2.2) | 2 (1.5) | 4 (8.7) | 1 (2) |
| Discontinued by provider | 2 (0.6) | 0 (0) | 0 (0) | 2 (4.3) | 0 (0) |
| Insurance type, N (%) | |||||
| Commercial | 154 (48.1) | 53 (57) | 64 (48.9) | 16 (34.8) | 21 (42) |
| Medicare | 113 (35.3) | 30 (32.3) | 48 (36.6) | 16 (34.8) | 19 (38) |
| Medicaid | 40 (12.5) | 7 (7.5) | 11 (8.4) | 12 (26.1) | 10 (20) |
| VA | 9 (2.8) | 1 (1.1) | 6 (4.6) | 2 (4.3) | 0 (0) |
| Uninsured | 4 (1.3) | 2 (2.2) | 2 (1.5) | 0 (0) | 0 (0) |
| Prior authorization, N (%) | 207 (64.7) | 90 (96.8) | 75 (57.3) | 20 (43.5) | 22 (44) |
| Appeals, N (%) | 56 (17.5) | 16 (17.2) | 26 (19.8) | 5 (10.9) | 9 (18) |
| Time to approval, days (median [IQR]) | 2 (0–10.8) | 5 (2–9.5) | 2 (0–14) | 1 (0–6) | 0 (0–14.5) |
| Medication cost, $ (median [IQR]) | |||||
| Drug cost | 595 (400–600) | 595 (595–595) | 400 (392–400) | 600 (600–619.3) | 980 (953–997) |
| Insurance copay | 70.5 (8–193.3) | 93 (30–180) | 88 (17.5–310) | 9.5 (0–86.8) | 41 (0–266.8) |
| Patient out-of-pocket cost | 7 (0–81) | 3.8 (0–5) | 9 (2.3–164) | 0 (0–28.9) | 25 (0–155) |
| Financial assistance, N (%) | |||||
| Copay card | 89 (27.8) | 41 (44.1) | 35 (26.7) | 5 (10.9) | 8 (16) |
| Patient assistance program | 30 (9.4) | 13 (14) | 14 (10.7) | 1 (2.2) | 2 (4) |
| Any insurance or cost intervention, N (%) | 236 (73.8) | 93 (100) | 93 (71) | 23 (50) | 27 (54) |
| Side effects, N (%)a | 73 (28.3) | 37 (41.6) | 12 (12.9) | 9 (23.7) | 15 (39.5) |
| Discontinued due to side effects, N (%)a | 15 (5.8) | 2 (2.2) | 6 (6.5) | 4 (10.5) | 3 (7.9) |
| Any insurance, cost, or side effect intervention, N (%) | 250 (78.1) | 93 (100) | 94 (71.8) | 28 (60.9) | 35 (70) |
| CV event on therapy, N (%)a | 7 (2.7) | 4 (4.5) | 0 (0) | 3 (7.9) | 0 (0) |
| ASCVD | 5 (1.9) | 4 (4.5) | 0 (0) | 1 (2.6) | 0 (0) |
| HHF | 2 (0.8) | 0 (0) | 0 (0) | 2 (5.3) | 0 (0) |
| CV death | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
ASCVD, atherosclerotic cardiovascular disease; CV, cardiovascular; EPA, eicosapentaenoic acid; GLP-1 RA, glucagon-like peptide-1 receptor agonists; HHF, hospitalization for heart failure; IQR, interquartile range; PCSK9i, protein convertase subtilisin/kexin type 9 inhibitors; SGLT2i, sodium-glucose cotransporter 2 inhibitors; VA, veterans administration.
a
To account for patients who initiated therapy, N is out of 258, 89, 93, 38, and 38 for combined, PCSK9i, EPA, SGLT2i, and GLP-1 RA cohorts respectively.