Familial Hypercholesterolemia (FH)
Today, the FH Foundation, is pleased to recognize UnitedHealthcare for streamlining its prior authorization process and expanding access to PCSK9 inhibitors for familial hypercholesterolemia (FH). These changes are making it easier and faster for doctors and patients who qualify to get access to these important therapies.
UnitedHealthcare updated its policy after reviewing new guidelines issued by the American College of Cardiology and the American Association of Clinical Endocrinologists and information provided by the FH Foundation, who presented data from their 40 clinical site CASCADE FH ® Registry. The FH Foundation is working with multiple health plans and policy makers as part of its FH Can’t Wait (#FHCantWait) campaign, which highlights the significant health risks individuals with FH face due to under-diagnosis and under-treatment.
“This is a great milestone in helping individuals with FH get the treatment they need to lower their cholesterol. We applaud UnitedHealthcare as this decision simplifies access for this largely invisible and misunderstood condition,” said Cat Davis Ahmed, vice president of policy and outreach for the FH Foundation.“The FH Foundation will continue to advocate on behalf of the 1.3 million Americans who have FH and will work together with insurers and policy makers on ways we can make appropriate treatments affordable and accessible for high-risk FH individuals.”

Prior authorization is an important step that assesses a number of criteria to identify patients who are appropriate candidates for the therapies, including personal and family medical history, previous use of statins and confirmation of benefits eligibility. By incorporating the newest clinical evidence into coverage criteria and making it easier to demonstrate the diagnosis of FH and previous intolerance to statins, UnitedHealthcare has greatly streamlined the prior authorization process and access to PCSK9 inhibitors for those who qualify to ensure treatment is provided to individuals for whom it is most indicated.
PCSK9 inhibitors are novel drug therapies that have been shown to lower LDL-cholesterol by 50-60% or more than can be achieved by statin therapy alone. They work by targeting and inactivating a specific enzyme (called proprotein convertase subtilisin/kexin type 9) thereby increasing the body’s ability to clear LDL-C from the bloodstream. Recent clinical trial results have shown that PCSK9 inhibitors reduce the risk for cardiac events as well as all-cause mortality.
Real People Impacted
Meet Dan. At 32, he had a quadruple bypass and was diagnosed with FH. He battled insurance for four months to get coverage of his much-needed therapy.

Help us get the word out that #FHCantWait

Meet Mackenzie. She did everything to try to outrun the FH genes in her family and is out of options. She meets the FH indication for PCSK9 inhibitors, but h as been denied by two different insurance plans .

We have to do better for people like Mackenzie.

Listen to the New Podcast About Access
with Katherine Wilemon
A Hidden Killer and Why Patients Face Barriers to Accessing Promising New Drugs for It

BioReport Podcast Highlights Need to Diagnose and Treat FH
In the News
New research published in Circulation highlights the continued lack of awareness of FH, and low prescription rate for statins to treat FH, a critical first-line therapy. The FH Foundation’s CASCADE FH Registry data shows the use of high intensity statins was even lower than data reported in the paper.

The FH Advocates for Awareness have been raising awareness of FH at local health clubs , offices and rotary clubs. Their presentations highlight the need to find the million people with FH that are undiagnosed in the U.S. Help us find FH #FINDFH.