Statins Industry Update

Industry Update: Statins


Statins In November 2016 the United States Preventive Services Task Force (USPSTF) recommended that adults without a history of cardiovascular disease (CVD) (ie, symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality for adults aged 40 to 75 years with no history of CVD, 1 or more CVD risk factors, and a calculated 10-year CVD event risk of 10% or greater. (See report here)

Background Information:

What’s the issue?

  • Decades of research clearly indicate a correlation between individuals with high levels of low-density lipoprotein-cholesterol (LDL-C) and an increased risk of developing atherosclerotic cardiovascular disease (ASCVD), condition where plaque builds up inside the arteries. ASCVD is the leading cause of cardiac events as heart attacks, strokes, and peripheral arterial disease.1, 2

Who gets ASCVD?

  • Almost anyone is prone to developing ASCVD. According to studies, individuals who are generally healthy and 40 years or older have a nearly 50% chance of developing a serious case of ASCVD. The risk increases with age.

Basis for treatment:

  • The Blood Cholesterol Expert Panel from the American College of Cardiology (ACC) and the Amercan Heart Association (AHA) reviewed studies of fixed doses of cholesterol lowering-drugs (statins) and issued an evidence-based update guideline in 2013 that recommended using statins to reduce the risk of ASCVD in adults 21 years and older.
  • In November 2016, The United State Preventive Services Task Force (USPSTF) issued a recommendation that adults ages 40-75 with no history of ASCVD take low to moderate dose statins if the following criteria are met:
    • They are age 40-75
    • They have one or more ASCVD risk factors (smoking, hypertension, dyslipidemia, or diabetes)
    • The individual has a calculated 10-year risk of a cardiovascular event of 10% or greater.

Low to moderate dose statin medications:

  • Atorvastatin 10 mg, 20 mg
  • Fluvastatin 20 mg, 40 mg
  • Fluvastatin ER 80 mg
  • Lovastatin 10 mg, 20 mg, 40 mg
  • Pravastatin 10 mg, 20 mg, 40 mg, 80 mg
  • Rosuvastatin 5 mg, 10 mg
  • Simvastatin 5 mg, 10 mg, 20 mg, 40 mg

What does this mean for you?

  • The USPSTF statin recommendation is effective for plan years beginning on or after November 13, 2017, requiring plan sponsors to cover these medications at no cost to members.
  • As with other ACA requirements, a plan sponsor may incorporate utilization management programs for these products.
  • You should work with your Pharmacy Benefit Manager to assure your pharmacy benefit is set appropriately to assure compliance.

Please download the Statin Industry Update Here.