New Data Reshapes Nonstatin Lipid Therapy Choices

The biggest obstacle in hyperlipidemia management isn’t a lack of treatment options, it’s getting patients’ low-density lipoprotein cholesterol (LDL-C) to goal, according to Kelsey Norman, PharmD, BCCP, BCACP, clinical pharmacy coordinator in the Cardiovascular Center at Boston Medical Center. Norman presented “Supporting Guideline-Driven Hyperlipidemia Care: The Pharmacist’s Prescribing Authority with Novel Lipid-Lowering Therapies” at the New England Institute of Ambulatory Care Pharmacists (NEIAP) 2026 Annual Forum in Boston, then spoke with Pharmacy Times about how newly published trial data and a newly recognized guideline role are changing what pharmacists can do about that gap.¹

Norman told Pharmacy Times that pharmacists have an edge that shorter physician, nurse practitioner, and physician assistant visits don't allow: Time.

"We’re able to meet with our patients for longer amounts of time than our physician and other provider colleagues," she said, and as lipid decisions grow more nuanced, pharmacists working under collaborative practice agreements “can really help continue those conversations, make adjustments, and then independently follow patients to get them to their goals faster.”

That authority now has firmer guideline backing. Although pharmacists are not specifically named in the lipid guidelines, Norman noted in her session that the 2026 American Heart Association/American College of Cardiology/American Diabetes Association/American Society of Nephrology cardiovascular-kidney-metabolic (CKM) syndrome guidelines identify clinical pharmacists as a key interdisciplinary team member for CKM care, an area that overlaps heavily with lipid management.²

Sequencing Therapy as LDL Targets Intensify

Norman’s approach starts with adherence, not a new prescription. “If they’re not adherent, adding on more things is just going to make it more complicated,” she told Pharmacy Times. Once existing therapy is optimized, she recommended weighing how much additional LDL lowering is needed among options that include proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors, ezetimibe (Zetia; Organon), and bempedoic acid (Nexletol; Esperion Therapeutics), factoring in patient preference, cardiovascular outcomes data, and cost.¹

In her presentation, she added that as LDL targets intensify, triple lipid-lowering regimens—which are historically uncommon—are becoming more necessary, even though the combined evidence base for 3-drug regimens remains comparatively thin. She also flagged a practical cost note for oral agents: Combining ezetimibe with bempedoic acid costs the same as the latter alone.¹

New Trial Data Reshaping the PCSK9 Inhibitor Conversation

Norman's session incorporated data from just the past year. The FDA-expanded indication for evolocumab (Repatha; Amgen), based on the VESALIUS-CV trial (NCT03872401), gives it randomized evidence for reducing cardiovascular events in high-risk patients with no prior MI or stroke—making it, per her presentation, the only PCSK9 inhibitor with that primary-prevention evidence; alirocumab (Praluent; Regeneron), by contrast, has secondary-prevention risk-reduction data but no primary-prevention outcomes trial.^1,3

On the horizon-agent front, she cited the Lp(a)HORIZON trial (NCT04023552) of pelacarsen (Novartis), which recently missed its primary end point of reducing cardiovascular death, nonfatal MI, nonfatal stroke, and urgent revascularization—leaving open, she said, whether other injectable Lp(a)-targeted agents in development will translate biomarker lowering into outcomes benefit. She distinguished obicetrapib, an oral CETP inhibitor, as a different case: It lowers LDL through a separate mechanism, with Lp(a) reduction only a secondary effect.^1,4

Overcoming Clinical Inertia and Building Real Adherence Habits

For pharmacists newly exercising prescribing authority, early obstacles are often about getting collaborating providers comfortable with newer options, sometimes through continuing education aimed at colleagues rather than the pharmacist. On adherence, Norman’s message was blunt: Refill history in the chart “does not always indicate medication adherence,” she said in her presentation, so it has to be asked about directly, at every visit. As a result, it’s easy to deprioritize since, unlike blood pressure, lipid panels aren't rechecked that often.¹

“I’m continually surprised when I talk about lipid goals and where patients are at—all of a sudden the discussion turns to, ‘Well, I only take my statin 3 days a week,’” she told Pharmacy Times, calling it “low-hanging fruit.” She added that continually discussing lipid results with patients improves adherence and reduces therapeutic inertia.¹

Matching Therapy to the Patient and Clearing Access Barriers

Beyond LDL reduction needed, Norman’s presentation walked through patient-specific factors that shape agent selection: diet, prior medication intolerances, health literacy with injectable therapies, needle phobia, dexterity and family support for self-administration, and refrigerated-storage access for patients experiencing housing instability. She also pointed to system-level tools: the PROMPT-Lipid trial (NCT04394715), a cluster-randomized study at Yale New Haven Health, found that individualized EHR alerts increased lipid-lowering therapy intensification compared with usual care—evidence, she said, that pharmacists can extend their reach beyond 1-to-1 visits.^1,5

For access barriers pharmacists encounter directly, Norman explained that documentation is decisive: clear notes on the LDL goal, rationale, and guidelines cited, paired with an updated lipid panel, help insurers approve therapy faster. She also advocated partnering with pharmacy technicians on prior authorizations, since “pharmacy technicians know how to navigate a lot of these insurance issues and can do a lot of this faster than we as clinicians can.”

Norman closed her session by noting a gap in the evidence pharmacists themselves could help fill: Lipid management has comparatively little published data on pharmacist-only interventions compared with fields like hypertension, and the ACC/AHA lipid guidelines specifically call out the need for randomized controlled trials involving pharmacists. Even small resident projects and case series, she said, could help close that gap.

REFERENCES

1. Norman K. "Supporting Guideline-Driven Hyperlipidemia Care: The Pharmacist's Prescribing Authority with Novel Lipid-Lowering Therapies." Session presentation and interview with Pharmacy Times. New England Institute of Ambulatory Care Pharmacists (NEIAP) 2026 Annual Forum; September 11, 2026; Boston, MA.

2. Ndumele CE, et al. 2026 AHA/ACC/ADA/ASN guideline for the prevention, detection, evaluation, and management of cardiovascular-kidney-metabolic syndrome: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;154(4):e50–e158. doi:10.1161/CIR.0000000000001453

3. Bohula EA, Marston NA, Bhatia AK, et al. Evolocumab in patients without a previous myocardial infarction or stroke (VESALIUS-CV). N Engl J Med. 2026;394(2):117-127. doi:10.1056/NEJMoa2514428

4. Novartis announces Lp(a)HORIZON Phase III topline results for pelacarsen in patients with elevated Lp(a) and established cardiovascular disease. Novartis. News release. Published September 4, 2026. Accessed September 18, 2026. https://www.novartis.com/news/media-releases/novartis-announces-lpahorizon-phase-iii-topline-results-pelacarsen-patients-elevated-lpa-and-established-cardiovascular-disease-cvd

5. Shah NN, Ghazi L, Yamamoto Y, et al. Pragmatic trial of messaging to providers about treatment of hyperlipidemia (PROMPT-LIPID): a randomized clinical trial. Circ Cardiovasc Qual Outcomes. 2024;17(5):e010335. doi:10.1161/CIRCOUTCOMES.123.010335