Barriers to Implementing PCSK9 Inhibitors in Clinical Practice

This segment centers on the persistent issue of medication adherence and the broader systemic barriers that prevent optimal low-density lipoprotein (LDL)–lowering therapy in high-risk patients. Even with powerful tools like inclisiran, which improves adherence through infrequent dosing, uptake remains hindered by outdated payer models and fragmented health care delivery. The conversation reframes nonadherence not as patient failure but as a consequence of misaligned incentives, limited consultation time, and administrative red tape.

The panel emphasizes that both access and persistence require structural reform. Providers face time constraints that limit patient education, while insurers enforce stepwise restrictions that delay appropriate therapy. Even when patients begin lipid-lowering regimens, long-term continuation rates drop off significantly. Data show this leads to higher event rates, underscoring that these are not short-term treatments but lifelong strategies to reduce cardiovascular risk.

To overcome these barriers, the group advocates for a paradigm shift toward prevention-focused care. Demonstrating cost-effectiveness through reduced hospitalizations and recurrent events can influence payers and policy makers. They call for trials that prove economic as well as clinical benefit, and for streamlining access through systemic changes. Ultimately, improving adherence and access will require a unified effort across patients, providers, health systems, and insurers.