More than 70 million low-income adults in the United States are insured by Medicaid, a population that experiences a high burden of cardiovascular diseases and mortality.1., 2., 3., 4., 5., 6. In this context, prevention and control of cardiometabolic risk factors such as hyperlipidemia, is critical. Over the past decade, available lipid lowering therapies have changed significantly, with the development of new high-cost, brand-name drugs (eg, proprotein convertase subtilisin/klexin type 9 [PCSK9] inhibitors) as well as the introduction of new generic formulations (eg, rosuvastatin, icosapent ethyl).7 As state Medicaid programs face increasing budgetary pressure, driven in large part by prescription drug spending, understanding contemporary patterns of utilization and spending on lipid lowering therapies in Medicaid is critically important.8

Therefore, in this study we aim to answer 3 questions. First, did utilization of lipid lowering medications change between 2018 and 2022 in Medicaid? Second, how has Medicaid spending on these medications changed over these same years? And third, how much would the Medicaid program save if brand-name drugs were substituted for available generics?