A powerful new class of drugs promises to change the management of heart disease for high-risk patients who struggle to get their cholesterol levels under control— a group that numbers in the millions. 

But only some of them are likely to get the new medicines.

The new drugs are expensive. And unlike a much cheaper class of pills called statins— which are proven to reduce cardiovascular risk— the jury is still out on whether the new drugs reduce serious events like heart attacks. For these reasons, many insurers plan to require rigorous evaluations before authorizing prescriptions, to make sure patients can’t get their cholesterol down with statins. 

An estimated 10 percent to 25 percent of people who have tried statins report having muscle pain, which limits the dose they can tolerate or precludes them from taking a statin at all.

Doctors who specialize in the condition, known as statin intolerance, say by changing statins or trying other strategies, many patients initially considered intolerant can end up taking a statin after all— which is the aim of payers who plan to aggressively challenge claims of statin intolerance.

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