How to Help Your Patients Find Nexlizet in Stock: A Provider's Guide

One of the most frustrating patient calls for a prescribing clinician is: "My pharmacy doesn't have my medication in stock." With Nexlizet (bempedoic acid/ezetimibe), this happens more frequently than with mainstream medications — and for reasons providers can often address proactively. This guide offers actionable strategies to help patients successfully fill Nexlizet prescriptions, from prior authorization to pharmacy referrals.

Understanding Why Patients Can't Fill Nexlizet

Most patient access failures with Nexlizet fall into three categories:

Pharmacy stocking. Not all pharmacies carry Nexlizet regularly. Smaller independent and rural pharmacies are least likely to stock it. Large chains (CVS, Walgreens, Costco) and hospital outpatient pharmacies are more reliable.

Insurance prior authorization. Despite reaching 92% of commercial insurance formularies and 65% of Medicare coverage, many payers still require prior authorization and step therapy documentation before approving Nexlizet.

Cost. At $430-$595/month retail, patients without the Esperion copay card may abandon the prescription at the pharmacy counter.

Strategy 1: Proactively Submit Prior Authorization Before the Patient Goes to the Pharmacy

One of the most impactful steps is submitting prior authorization before you even send the prescription to the pharmacy. This prevents patients from showing up at the pharmacy and being turned away due to a pending auth.

Key documentation for PA approval typically includes:

Diagnosis: hyperlipidemia (ICD-10: E78.5) or HeFH (E78.01), or cardiovascular disease with elevated LDL

Documentation of statin intolerance (prior AEs, elevated CK, myalgia) or step therapy with prior agents

Most recent LDL level and treatment goal

Medication history demonstrating prior use of statins and/or ezetimibe

Esperion's NEXSTEP Navigator program can provide PA support. Contact navigator@esperion.com or call 855-699-8814.

Strategy 2: Direct Patients to the Right Pharmacies

When writing the prescription, consider annotating the prescription or giving patients verbal guidance on which pharmacies are most likely to stock Nexlizet:

Best options: CVS, Walgreens, Costco, Walmart, hospital outpatient pharmacies affiliated with cardiology centers

Mail-order: Express Scripts, OptumRx, CVS Caremark for long-term/maintenance patients — often with 90-day supply options

Less reliable: Independent community pharmacies, rural pharmacies, and pharmacies in areas with low cardiology practice density

Strategy 3: Counsel Patients on the Esperion Copay Card and Cost Assistance

A significant barrier to medication adherence is cost abandonment — patients who receive a prescription but don't fill it due to price. For Nexlizet, Esperion offers the NEXSTEP Copay Card:

Eligible commercially insured patients may pay as little as $10 per fill

Patients can enroll at www.NexCopay.com or call 855-699-8814

NOT eligible for Medicare, Medicaid, TRICARE, or VA patients

Annual re-enrollment required; eligibility is for one year

For uninsured or underinsured patients, GoodRx coupons can reduce Nexlizet cost to approximately $231/month — still expensive, but significantly less than retail. For patients on government programs who face high out-of-pocket costs, discuss covered alternatives or apply for the Esperion Patient Assistance Program through NeedyMeds or RxAssist registries.

Strategy 4: Use medfinder to Help Patients Locate In-Stock Pharmacies

medfinder is a service designed to help patients track down hard-to-find prescriptions. Patients enter their medication and zip code, and medfinder calls nearby pharmacies to identify which ones can fill the prescription. Results are texted directly to the patient. Providers can direct patients to medfinder.com/providers for more information on how to integrate this into your practice workflow.

Strategy 5: Offer Bridge Therapy While Awaiting Prescription Resolution

If a patient's Nexlizet prescription is stuck in prior auth review or the pharmacy is awaiting a special order, prescribing a short supply of generic ezetimibe 10 mg (as a bridge) maintains the intestinal cholesterol absorption component of Nexlizet and prevents a treatment gap. Ezetimibe is widely available, inexpensive, and typically doesn't require prior authorization.

For a deeper dive into Nexlizet's shortage status and clinical context, see our provider article: Nexlizet shortage: what providers need to know in 2026.