Clinical Considerations for Healthcare Provider-Administered Lipid-Lowering Medications

Area of Science:

• Cardiology
• Pharmacology
• Health Economics

Background:

• Atherosclerotic cardiovascular disease (ASCVD) poses a significant global health burden.
• Achieving low-density lipoprotein cholesterol (LDL-C) goals is critical for ASCVD management, yet many patients do not attain target levels.
• Suboptimal adherence and utilization of lipid-lowering therapies (LLTs) contribute to poor outcomes, influenced by factors like polypharmacy, side effects, and access.

Purpose of the Study:

• To explore the implications of the buy-and-bill reimbursement model for healthcare provider-administered lipid-lowering therapies in cardiology.
• To provide a practical guide for implementing novel, in-office administered specialty drugs within US clinical practice.
• To assess how in-office administration may enhance patient monitoring, adherence, and cardiovascular outcomes.

Main Methods:

• Discussion of the buy-and-bill process for medical benefit drugs in the US.
• Analysis of inclisiran as a novel, twice-yearly, in-office administered LLT.
• Consideration of infrastructure and process changes for cardiology practices.

Main Results:

• In-office administration of LLTs, such as inclisiran, allows for greater healthcare provider control over drug acquisition, administration, and reimbursement.
• The buy-and-bill model, established in other specialties, can facilitate timely care and potentially improve patient adherence.
• Implementation requires adaptation but may lead to improved cardiovascular outcomes for ASCVD patients.

Conclusions:

• The buy-and-bill model presents an opportunity to optimize LLT delivery and adherence in ASCVD management.
• HCP-administered specialty drugs can enhance patient monitoring and timely treatment initiation.
• Adoption of this model in cardiology may improve the attainment of LDL-C goals and reduce the burden of ASCVD.