J Manag Care Spec Pharm. 2026 May 6:1-11. doi: 10.18553/jmcp.2026.26004. Online ahead of print.
ABSTRACT
BACKGROUND: Elevated low-density lipoprotein cholesterol (LDL-C) leads to atherosclerotic plaque buildup and drives cardiovascular disease. Despite the availability of effective therapies for LDL-C reduction, elevated LDL-C is common in the United States.
OBJECTIVE: To measure the success of a pharmacist-led telephonic outreach program designed to proactively address individuals with hyperlipidemia who were not being treated in accordance with cholesterol guidelines and collaborate with their primary care clinicians (PCCs) to increase guideline-based care.
METHODS: The 3-month outreach occurred from September through November 2023. Health plan members with 1 inpatient or 2 outpatient claims for hyperlipidemia within the previous year were determined using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Members not managed in accordance with the 2018 American Heart Association/American College of Cardiology (ACC)/Multisociety Guideline and 2022 ACC Expert Consensus Decision Pathway, based on available claims data, received a personalized action recommendation. The outreach team contacted the member and scheduled a phone call with a pharmacist. If the member agreed to the pharmacist's clinical recommendation, the outreach team contacted the member's PCC directly (by fax or e-mail). PCCs were responsible for the final clinical decision and action.
RESULTS: Of 14,979 members who met the inclusion criteria, 883 were selected at random for contact by the outreach team. Of these, 667 members (76%) accepted a call with a pharmacist and were considered the intervention group. An additional 5,266 members who were not contacted and did not share a PCC with someone in the intervention group were included as the control group. In the intervention group, 92.4% of members accepted the guideline-based hyperlipidemia recommendation, allowing the pharmacist to contact their PCC. The overall percentage of members moving toward guideline-recommended care in the intervention group (25.5%) was approximately twice that in the control group (11.1%). Members could undergo an LDL-C test if they had no LDL-C result available, initiated lipid-lowering therapy (LLT) if they were not already being treated for hypercholesterolemia, or intensified their existing statin regimen or added a nonstatin LLT. The difference in proportion of members remaining on no statin throughout the program was significantly lower in the intervention group (-7.9% [95% CI = -11.3% to -4.5%]) vs the control group. At the end of the pilot, 8.7% (58 of 667) of intervention group members received LLT in accordance with current guidelines vs 6.0% (316 of 5,266) in the control group.
CONCLUSIONS: This study demonstrated that a health plan-driven, pharmacist-led, educational outreach program increased movement toward guideline-based LDL-C management in a 3-month pilot. Similar programs could increase the proportion of members receiving guideline-based care in a variety of chronic disease settings.
PMID:42089871 | DOI:10.18553/jmcp.2026.26004