Ty Gluckman, M.D., on what the new lipid guidelines mean for payers | HSES 2026

The 2026 dyslipidemia guideline is built around simplicity, bringing back LDL cholesterol goals defined by risk group, according to Ty Gluckman, M.D., medical director of the Center for Cardiovascular Analytics, Research and Data Science at the Providence Heart Institute in Portland, Oregon. Gluckman spoke with Managed Healthcare Executive at the 2026 Health System Executive Summit.

Testing and treatment rates are well below where they should be, Gluckman said, and primary care clinicians manage a large share of patients being treated for lipids, so the guideline needed to be easier to apply. “Ultimately, we want to be more aggressive in those who are at higher risk in order to minimize their risk for adverse events,” he said.

The new LDL cholesterol targets are more intensive than in the past, though not as intensive as European guidance, which sets goals below 40 mg/dL for the highest-risk groups, he said. Reaching them starts with intensive lifestyle changes and statins, which are first-line therapy for everyone and available as generics. For patients not at goal on maximally tolerated statin therapy, the next step is a non-statin: oral ezetimibe or bempedoic acid, both supported by outcomes data, or a PCSK9 monoclonal antibody, which also has outcomes data. Inclisiran, which doesn’t yet have outcomes trial data, is listed as an alternative to the monoclonal antibodies for patients who prefer its dosing regimen. The order, Gluckman said, was largely set by putting statins first, followed by therapies with trial data showing reductions in fatal or nonfatal cardiovascular events.

The biggest barrier isn’t a lack of tools but how they’re used, he said, pointing to “clinical or therapeutic inertia” and the sense that “close is good enough.” For managed care, that means making sure patients get tested and that those who need therapy started or intensified receive it.

Access to PCSK9 inhibitors has improved considerably since their 2015 approval, when denial rates were often high, Gluckman said. List prices have come down and authorization rates have appreciably improved. Getting the drugs authorized still takes work, he said, “but it is far more straightforward and far easier to get the drugs approved than it was 11 years ago.”

In this video, Gluckman walks through what changed in the guideline, how the treatment sequence was set and what still stands between patients and their LDL goals.