New Data Show Certain Demographics are Denied Cholesterol-Lowering Medication More Often

Medication access remains a hurdle for many patients, especially those prescribed cholesterol-lowering PCSK9 inhibitors.

New data reveals that health plans reject women, southerners, and Black and Hispanic people’s prescriptions for PCSK9 inhibitors more often than they reject whites. The findings appear in a new policy brief, “Rejected: How Life-Saving Heart Medication Eludes Women, Southerners & People of Color” released by the Partnership to Advance Cardiovascular Health. 

Key Findings  

The report details 2019-2021 commercial insurance claims data for cholesterol-lowering PCSK9 inhibitors, which show that: 

• Women are rejected 21% more often than are men 

• Rejection rates in Arkansas are 67% higher than the national average, while rejection rates in Mississippi and Oklahoma are 29% higher than the national average   
• Black patients face a 20% higher rejection rate than whites do, and Hispanic patients face a 25% higher rejection rate than whites do. 

The report also reveals that patients in more than one of the impacted populations can be doubly affected.  

• Women in Arkansas have a 74% higher rejection rate than the national average 

• Hispanic women are rejected at a 17% higher than the national average. 

Throughout the United States, certain health plans reject patients’ claims for PCSK9 inhibitors at higher rates than others. The data also identified organizations with the highest rates of rejection for cholesterol-lowering PCSK9 inhibitors.  

Several plans rejected three-fourths or more of claims: 

• Moda Health Plan (87%) 
• Maxor Plus (86%) 
• Federal Employee Benefit Plan (75%). 

The Blue Cross network, which covers 107 million members in multiple plans across the country, appears three times in the list of plans with the highest rejection rates: 

• Blue Cross Blue Shield Arizona (51%) 
• Blue Cross Blue Shield Arkansas (45%) 
• Blue Cross Blue Shield Mississippi (36%). 

About PSCK9 Inhibitors 

PCSK9 inhibitors, which first came to clinic in 2015, are injectable drugs designed to lower high LDL cholesterol. Typically, PCSK9 inhibitors are prescribed to patients who cannot get their LDL cholesterol down enough through statins alone. PCSK9 inhibitors have been shown to decrease LDL cholesterol by up to 70% and cut the risk of a heart attack by almost one-third. 

Heart disease kills nearly 659,000 people in the United States each year. The data show that those disproportionally affected by heart disease are also being denied access to live-saving cholesterol-lowering medication. Commercial insurers should provide premium-paying patients access to their prescribed medication, regardless of gender, race or geographic location.