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DUR: Lipotropics and Liver Function/Cholesterol Testing in the Medi-Cal Fee-For-Service Population

Drug Use Review: Educational Information

High cholesterol is a major contributor to coronary heart disease (CHD). There are approximately 100 million people with high cholesterol (>200mg/dL) in the United States.1 Heart disease is the leading cause of death in the United States. High cholesterol attributes to narrowing of the arteries and plaque formation in coronary arteries.2 High cholesterol is a changeable risk factor in heart disease. Some instances of high cholesterol can be familial, but diet also contributes to a patient’s total cholesterol count.

There are different types of medications used to help lower cholesterol levels in the body. These include HMG-CoA Reductase Inhibitors (statins), other anti-lipemic agents (non-statins) and combination therapy. In addition to pharmacologic treatment for high cholesterol, there are also therapeutic lifestyle changes (TLC) that are essential to assist in the lowering of cholesterol.3

The Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel
III – ATP III) recommends that providers follow a progression of drug therapy and cholesterol evaluation schedule. They suggest the following:4

  • Initiate LDL-lowering drug therapy and check cholesterol levels in six weeks.
  • If the LDL goal is not realized, increase the dose of medication or add another type of cholesterol-lowering medication to the current regimen and recheck in six weeks.
  • If the LDL goal is met, then continue the course of treatment including therapeutic changes and recheck every four to six months. If the goal is not met, then consider a referral to a specialist.

A retrospective study of Medi-Cal fee-for-service (FFS) recipients was conducted to determine if providers are following ATP III guidelines for cholesterol testing in patients starting cholesterol drug therapy. Since laboratory test results are not available to Medi-Cal to determine if lower cholesterol levels were achieved, the study focused on whether there was appropriate follow-up after patients began cholesterol drug treatments. Cholesterol testing included both cholesterol screening tests and liver function tests. Patients who were continuously eligible for 11 out of 12 months during the period of October 2005 through September 2006 and started cholesterol drug therapy between January through June 2006 were included in the study.

  • 11,317 Medi-Cal recipients who met the continuous eligibility criteria had at least two claims for cholesterol medications during the study period, and had no claims for cholesterol medications in the last six months of 2005.
– 60 percent had follow-up testing after starting drug therapy, though only 32.5 percent of the recipients had follow-up testing within the ATP III guidelines.

– 71 percent of recipients were tested prior to beginning cholesterol drug therapy.


Cholesterol Testing of Beneficiaries Starting Cholesterol Drug Therapy Jan-Jun 2006

The above results show that providers are providing follow-up care for their patients on cholesterol medications. Medi-Cal wants to make certain that recipients that utilize cholesterol medication are getting the best possible care.

  • Providers should follow the current ATP III guidelines and other best practices with respect to initiating therapy and laboratory follow-up.
  • Pharmacists can use prescription consultation as an opportunity to remind patients to have their cholesterol tested at the proper times after initiating or changing therapy. The pharmacist can encourage them to make appropriate lifestyle changes to help lower their cholesterol through non-pharmacologic means.
  • Providers and pharmacists should consult their patients on the side effects of these medications, and the importance of using these medications correctly. Patients should also be monitored and informed about possible drug-drug interactions if they are taking more than one cholesterol-lowering medication.
  1. American Heart Association. Heart Disease and Stroke Statistics – 2006 Update. Dallas, TX: American Heart Association; 2006 at www.americanheart.org.
  2. National Committee for Quality Assurance (NCQA). Cholesterol Management After a Heart Attack. State of Health Care Quality Report, 2003.
  3. Grundy, S, Cleeman, J, et al. Implications of Recent Clinical Trials for the National Cholesterol Education Program (NCEP) Adult Treatment Panel III Guidelines. Circulation. 2004; 110: 227-239.
  4. National Cholesterol Education Program. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III). Bethesda, MD: National Institutes of Health; 2002.