Pharmacists Can Close the LDL Control Gap in Lipid Care

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 the widest gap in day-to-day hyperlipidemia management and how pharmacists can use collaborative practice agreements and structured decision-making to close it.

Norman identified getting low-density lipoprotein (LDL) cholesterol to goal as the central gap. She argued that pharmacists are uniquely positioned to help because they can spend more time with patients than physicians, nurse practitioners, and physician assistants, whose visits are shorter. As lipid-lowering decisions grow more nuanced and require more shared decision-making, she said, pharmacists working under collaborative practice agreements can continue those conversations, adjust therapy, and independently follow patients to reach goals faster than the medical team could alone.

On selecting among newer agents, Norman said the first step is assessing adherence to current therapy, since adding medications to a non-adherent regimen only adds complexity. Once existing therapy is optimized, she recommended matching the degree of LDL reduction needed to the appropriate agent—considering proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors across their various modalities alongside ezetimibe (Zetia; Merck) and bempedoic acid—while incorporating patient preferences. She emphasized weighing available evidence, including whether cardiovascular outcome data exist and whether the patient has established cardiovascular disease, and discussing the pros and cons of each option with the patient.

Norman also acknowledged that insurance heavily shapes these decisions: lower-cost options the patient is already taking factor in first, while emerging therapies, which are more expensive for most patients, often prompt payer-driven conversations. Throughout, she framed the pharmacist as the team member best equipped to manage this complexity.