Harvard Pilgrim encourages the providers in our network to prescribe statins to members diagnosed with diabetes, and we offer support and coverage to facilitate statin use.
According to guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHS), lowering LDL-C levels in patients with diabetes helps manage risk factors for atherosclerotic cardiovascular disease (ASCVD). While diabetes itself is an independent risk factor for ASCVD, this risk is exacerbated by the combination of diabetes with hypertension and dyslipidemia. Harvard Pilgrim recommends the ASCVD risk calculator provided by the ACC to estimate a given patient’s 10-year risk, but ACC, AHS, and American Diabetes Association guidelines indicate that patients 40 to 75 years of age with diabetes mellitus and an LDL-C level of ≥70 mg/dL should be started on moderate-intensity statins without the need to calculate their 10-year ASCVD risk.
In accordance with clinical guidelines, Harvard Pilgrim recommends that statins be the first line of defense before non-statins if the patient can tolerate a high-intensity statin, and that ezetimibe and PCSK9 inhibitors (e.g., Praluent, Repatha) be reserved for patients with cardiovascular disease who are statin intolerant or cannot achieve the desired LDL lowering. Praluent and Repatha should be used in combination with an optimized regimen of lipid-lowering therapy unless the patient exhibits statin intolerance.
While some patients may incorrectly be under the impression that you should avoid statins if you have diabetes, people with diabetes benefit the most from statins, which reduce their risk of heart attack, stroke, and death. Statins may increase blood sugars, but this does not offset the overall health benefit that statins provide. Patients prescribed statins should monitor their blood sugars, with their diet, and include regular exercise in their routines.
Harvard Pilgrim supports the use of statins in patients with diabetes by covering several generic statins on both the Commercial (Premium, Value, Core NH) and Medicare Advantage formularies. For Commercial members, we offer the following preferred generic formulary antilipemic agents at $0 cost share: atorvastatin 10 mg and 20 mg, simvastatin, and lovastatin. For Medicare Advantage members, we offer the following preferred generic formulary antilipemic agents on tier 1: atorvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. Medicare Advantage members pay a $0 copay for Tier 1 drugs up until the catastrophic coverage phase of their plan.
We encourage the use of e-prescribing for elderly patients to mitigate barriers to pharmacy access as well as provider access. As a reminder, OptumRx is Harvard Pilgrim’s pharmacy benefit manager, and you can obtain a 90-day mail order supply of statins by submitting a mail service prescription to OptumRx Home Delivery.
Director, Network Operations