John A. Johnson, MD, MBA: The PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors are fairly new medications that have become available, and, again, as we’ve mentioned earlier, the statins are also available.
We’ve seen that even with maximum statin therapy with drugs such as Crestor or Lipitor (at the maximum dose), it’s still a challenge for some clinicians to get their hyperlipidemic patients to an LDL (low-density lipoprotein) below goal. Again, the goal depends on the risks the patient has. But, in general, an LDL below 100 would be acceptable for a diabetic or below 70 for a diabetic with heart disease.
So, it’s oftentimes difficult to push the statin to a high enough dose without causing some of the safety or tolerability concerns [for] the patient. You may have to move toward a combination therapy, and newer agents are becoming available. At the health plan [level], we make those medications available when we’ve seen documentation that other medications are less effective.