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Making LDL Matter Again: Addressing Clinical, Patient, and Payer Barriers in ASCVD Management : Episode 12
Payer and Prior Authorization Barriers
Panelists discuss how payer controls and prior authorization policies delay and derail LDL-lowering therapy.
EP: 1.Understanding the Current State of LDL-C Goal Attainment and Barriers to Adequate Control in Hyperlipidemia
EP: 2.Challenges with Undertreatment in Hyperlipidemia and Opportunities to Address this Gap
EP: 3.Pharmacy-Driven Challenges
EP: 4.Real-World Insights and PROMPT-LIPID
EP: 5.Social Determinants of Health
EP: 6.The 2013 Guideline Shift
EP: 7.Unintended Consequences of Metric Changes
EP: 8.Reinstating LDL-C Targets
EP: 9.International LDL Thresholds
EP: 10.Nonstatin Therapy Decisions
EP: 11.PCSK9 Inhibitor Underuse
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EP: 12.Payer and Prior Authorization Barriers
EP: 13.Adherence and Persistence
EP: 14.Cumulative LDL-C Exposure
EP: 15.Economic Burden and Systemwide Strategies
Panelists discuss how payer utilization management and prior authorization processes delay therapy initiation and contribute to high abandonment rates.
The paperwork burden discourages prescribers and frustrates patients, often interrupting continuity of care. Panelists highlight that these barriers disproportionately affect lower-income populations and smaller practices.
They recommend policy reforms that balance cost control with clinical flexibility, enabling timely treatment for high-risk individuals.
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