How Pharmacists Overcome PCSK9 Inhibitor Access Barriers

At the New England Institute of Ambulatory Care Pharmacists (NEIAP) 2026 Annual Forum in Boston, Massachusetts, Kelsey Norman, PharmD, BCCP, BCACP, clinical pharmacy coordinator in the Cardiovascular Center at Boston Medical Center, discussed how pharmacists newly exercising prescribing authority can initiate, monitor, and support adherence to proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitor therapy and how to move appropriate patients past access barriers faster.

Norman said one early obstacle is clinical inertia among collaborating providers. Ensuring supervising and collaborating clinicians are comfortable with newer non-statin options—sometimes through continuing education aimed at colleagues rather than the pharmacist—helps a practice adopt them. In busy primary care visits, she noted, the PCSK9 inhibitor and its injection are often the last thought, which is precisely where pharmacists can step in.

On adherence, Norman's central message was to talk about it consistently. Because clinicians often focus on conditions with daily home monitoring, such as diabetes and hypertension, cholesterol can be overlooked; lipid panels are typically checked only once a year unless therapy is changing. She said she is regularly surprised to learn a patient is skipping their statin several days a week—often low-hanging fruit with a large impact. For self-injected PCSK9 inhibitors, she suggested reminders and smart devices, noting that monthly injections can be harder to remember than every-2-week dosing and that a newer daily oral option may suit some patients.

To streamline access, Norman recommended clear documentation of the rationale, low-density lipoprotein goal, and cited guidelines, along with updated lipid panels—often required within 6 months to a year by payers. She also advocated partnering with pharmacy technicians, who can navigate insurance issues faster than clinicians.