ATTR-CM is a rare, progressive disease that can cause heart failure and other complications for the approximately 100,000 people in the United States living with it. 

ATTR-CM is treated with two categories of specialty drugs: transthyretin (TTR) stabilizers and TTR gene silencers. Tafamidis (Vyndamax) is a TTR stabilizer with an estimated list price of $235,000 annually — though independent, nonprofit researcher Institute for Clinical and Economic Review (ICER) says this drug would be cost effective at a price range of $13,600 to $39,000 per year. 

Traditionally, a combination of various tests — including imaging and potentially an invasive heart biopsy — were required to pinpoint an ATTR-CM diagnosis with accuracy. But, gone are the days when heart biopsies were the gold standard. 

Diagnostics: A new era 

Today, nuclear scintigraphy — or bone scans — using Tc-PYP tracers is taking center stage. This noninvasive method, when paired with negative monoclonal protein tests, boasts a 100% positive predictive value for ATTR-CM. 

From 2017–19 for Medicare fee-for-service members, Tc-PYP use increased by 42% and biopsy use dropped by 38%.¹ The shift in utilization may be credited to greater awareness, better treatment options and a growing recognition of ATTR-CM as a key driver of heart failure in older adults. 

“ATTR-CM therapies are gaining traction—along with rising costs,” said Tim Heuring, PharmD, clinical account director at Prime. “In four years’ time, spending in this category increased tenfold for Medicare Part D members.² That’s why it’s so important we stay ahead of this trend to help our clients manage their members’ care with the most clinically sound and cost-effective therapies.” 

Prime’s holistic strategy 

Prime is tackling the ATTR-CM challenge with a multi-pronged approach including: 

• Expert Clinical Network & High-Cost Therapy program 
  Independent key opinion leaders help shape Prime’s utilization management criteria and review cases, helping to ensure the right patients get the right therapies. 

• HighTouchRx^®  
  With Prime’s award-winning clinical program, pharmacists identify members on duplicative ATTR drugs and intervene. So far, this has eliminated duplicate therapy in two cases, saving $0.5 million. 

Looking ahead 

Prime is tracking trends in combination therapy  — using both TTR stabilizers and silencers  — and preparing for deeper insights to share at future managed care pharmacy sector conferences.  

For a deeper understanding of ATTR-CM diagnosis, treatment and management, read the latest edition of the Prime Therapeutics Report,  which offers an in-depth analysis of trends associated with high-cost, innovative therapies and the latest updates to inform Prime clients’ coverage and benefit decisions.   

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References

1. Bourque JM, Schepart A, Bhambri R, et al. Temporal trends in diagnostic testing patterns for wild-type transthyretin amyloid cardiomyopathy in the Medicare fee-for-service population. The American Journal of Cardiology. 2022;167:98-103. 
2. Data.CMS.gov. Medicare Part D Spending by Drug. Accessed 07.07.2025.