12 March 2018 - Tommy Mann's dad had his first heart attack when he was 29. That's how he found out that he had a genetic disorder, familial hypercholesterolaemia, that causes very high cholesterol levels. 

Tommy and his two sisters have familial hypercholesterolaemia, too. Even on the top dose of cholesterol pills, Tommy Mann's low-density lipoprotein, or LDL, is 170 mg/dL – worse numbers than most people with high cholesterol have before they start medicine.

Mann, a 37-year-old lawyer, found an injection, called a PCSK9 inhibitor, that could lower his LDL to just 50 mg/dL. The problem: His insurer, United Healthcare, has been denying his requests for it for more than two years. PCSK9 inhibitors cost $14,000 a year, triple what older cholesterol drugs cost before they went generic, and have become a front line in the war over drug prices. And so Mann's pleas – that his father died after a heart transplant, that his sister had a heart attack, that he has small children – fell on deaf ears.

"You're tucking your kids in at night and you get a letter that we're not going to cover you because you haven't had a heart attack yet," Mann says.

Read Forbes magazine article