Hypercholesterolimia screening and management

Applies to:

All plans

Definition

From medicinenet.com: Hypercholesterolemia is one form of hyperlipidemia. Familial hypercholesterolemia is the most common inherited type of hyperlipidemia (high fat or lipid levels in blood). It predisposes to premature arteriosclerosis including coronary artery disease with heart attacks at an unusually young age.

Hypercholesterolemia clinical practice guideline

Lipid Management Clinics

Statin therapy does not always help patients meet therapeutic goals, either due to intolerance or therapeutic failure. To help these patients, we have developed Lipid Management Clinics.

Members meet with cardiologist or lipidologist, receive a medical history review, and develop a treatment regimen to lower their LDL.

Members of all Priority Health plans are eligible. You may refer patients to a Lipid Management Clinic at any time whether or not they qualify for a PCSK9 inhibitor drug.

Coverage for Lipid Management Clinic visits

  • Visit to a physical clinic: Copay/cost varies, see the list of clinics
  • Virtual visit through MedNow: $70, which applies to the member's deductible

Become a Lipid Management Clinic

Providers can ask to be added to our list of clinics. Email the Priority Health Pharmacy Help Desk

Clinics list

Lipid Management Clinic criteria

Clinics must be:

  • Led by a board-certified cardiologist or lipidologist
  • Open to referrals of patients with lipid abnormalities or statin intolerance
  • Experienced in the differential diagnosis of statin intolerance and managing re-institution of statin therapy in statin-intolerant patients