"There's a Vacuum That a Pharmacist Is Uniquely Qualified to Fill": Medication Adherence and Pharmacoequity in Lipid Care

Mary Katherine Cheeley, PharmD, BCPS, CLS, FNLA, argues that while providers know how to start lipid-lowering therapy, the real gap is keeping patients on it. She makes the case for pharmacists at every level—clinical, retail, and specialty—playing a central role in formulary navigation, prior authorizations, and long-term adherence support. She also introduces the concept of pharmacoequity: ensuring patients have equal access not just to medications, but to clinical trials and the full landscape of therapeutic options.

Q: Pharmacists are increasingly stepping into expanded clinical roles. Where do you see the biggest opportunity for pharmacists to make a measurable difference in patient outcomes in lipid management today?

Mary Katherine Cheeley, PharmD, BCPS, CLS, FNLA: I am super biased — let’s start there. I think pharmacists should have a hand in all of this. Part of it is prior authorizations—we actually have a paper coming out from the NLA on that—and that is a huge barrier for our patients. That is a space where clinical pharmacists, retail pharmacists, and med adherence pharmacists can play a huge role. Having our pharmacists involved at the onset—which medication are we requesting and which one are we prescribing for the patient—is step one: knowing formulary management. In addition to that, making sure the patient is adherent to it. Specialty pharmacy has done a great job of making sure patients are adherent to high-cost meds, but we need the same support for our small molecule statins and fibrates. Those two things are huge.

I also think there is a really big unmet need in the population health space. Pharmacists are really great at understanding the continuum of how the patient accesses their medical care. How do you get to the doctor? How do you get to the pharmacy? What are your barriers? Something else that I’m really passionate about is pharmacoequity. We always talk about health equity, but there’s also equity in the drug space—making sure our patients have access to all the clinical trials they want to be a part of and that they understand how that process works.

If I had to pick one — because your question was about the biggest opportunity — I think the biggest opportunity for pharmacists is in adherence. Our providers know to start statins. Our providers want to start PCSK9 monoclonal antibodies or PCSK9-targeted therapies. They want newer agents for Lp(a). What they don’t do a great job at, and what they don’t have the bandwidth for, is making sure that patients are adherent to those meds. It doesn’t matter if I prescribe the right one on day one if you can’t get to the pharmacy to get it. And then it doesn’t matter if you can pick it up the first time if you’re not going to get it the second, third, and fourth time. That’s where there’s a vacuum — a hole that a pharmacist is uniquely qualified to fill.