Nexlizet Shortage: What Providers and Prescribers Need to Know in 2026

Patients prescribed Nexlizet (bempedoic acid/ezetimibe) are increasingly reporting difficulty locating it at retail pharmacies. While Nexlizet is not currently on the FDA Drug Shortage Database, providers should understand why patients face access challenges and what clinical options are available when Nexlizet is not fillable. This guide provides a provider-level overview of the 2026 landscape.

Current Nexlizet Availability Status (2026)

As of 2026, Nexlizet is not in an official FDA-declared shortage. Esperion Therapeutics has not reported manufacturing or supply chain disruptions. However, providers are seeing patients return with unfilled prescriptions for several operational and formulary reasons:

No generic formulation. Nexlizet remains brand-name only as of 2026. Pharmacies with low dispensing volume for this drug class often do not maintain regular inventory.

Prior authorization requirements. Despite broad formulary placement (>136 million commercial lives and 34 million Medicare lives as of September 2024), many plans still require prior authorization. Step therapy — requiring documented statin intolerance or inadequate response — is common.

High retail price. Without insurance or the Esperion co-pay card, the retail cash price is $430-$595/month. Patients without adequate coverage may abandon the prescription.

The 2024 FDA Label Expansion and Its Clinical Implications

In March 2024, the FDA approved significant label expansions for Nexlizet and its sister medication Nexletol (bempedoic acid monotherapy). These expansions are clinically relevant for prescribers:

Nexlizet is now indicated for primary hyperlipidemia, alone or in combination with a statin — removing the prior requirement for maximally tolerated statin therapy as background treatment

The bempedoic acid component is indicated to reduce risk of MI and coronary revascularization in adults unable to take recommended statin therapy — in both primary AND secondary prevention populations

These approvals were based on the CLEAR Outcomes trial (N=13,970), which demonstrated a 23% relative reduction in myocardial infarction and a 19% reduction in coronary revascularization with bempedoic acid vs. placebo in statin-intolerant patients (median follow-up 3.4 years)

Pharmacodynamics: Why Nexlizet Works Differently from Statins

Nexlizet's two mechanisms of action are complementary and target two separate pathways:

Bempedoic acid (ACL inhibitor): Inhibits ATP-citrate lyase, two steps upstream of HMG-CoA reductase (the statin target). Bempedoic acid is a prodrug activated by ACSVL1 in the liver, but not in skeletal muscle — which explains its lower rate of myopathy compared to statins. Mean LDL reduction: ~17-21% as monotherapy.

Ezetimibe (NPC1L1 inhibitor): Blocks intestinal absorption of dietary and biliary cholesterol via the Niemann-Pick C1-Like 1 transporter. Mean LDL reduction: ~15-20% as monotherapy.

Together, the combination achieves approximately 35-38% LDL reduction from baseline — making Nexlizet a clinically meaningful option particularly for statin-intolerant patients who need more than ezetimibe alone.

Key Drug Interactions Prescribers Must Know

Before prescribing Nexlizet, counsel patients and review concurrent medications:

Simvastatin >20 mg/day: Bempedoic acid inhibits OAT2 transport, increasing simvastatin and pravastatin plasma concentrations. Avoid simvastatin doses exceeding 20 mg/day concomitantly with Nexlizet.

Pravastatin >40 mg/day: Same mechanism; cap pravastatin at 40 mg/day when co-prescribed with Nexlizet. Atorvastatin and rosuvastatin show only a 1.7-fold AUC elevation (generally within acceptable statin exposure ranges and not dose-restricted).

Cyclosporine: Co-administration with ezetimibe increases exposure of both cyclosporine and ezetimibe. Monitor cyclosporine levels closely if Nexlizet is initiated in transplant patients.

Fibrates (non-fenofibrate): Concomitant use increases risk of cholelithiasis. Coadministration with fibrates other than fenofibrate is not recommended.

Bile acid sequestrants: Administration with cholestyramine reduces ezetimibe AUC by 55%. Administer Nexlizet at least 2 hours before or 4 hours after bile acid sequestrants.

Evidence-Based Alternatives When Nexlizet Is Not Accessible

When Nexlizet cannot be dispensed, consider these evidence-based options based on the patient's risk profile:

Generic ezetimibe 10 mg daily: Maintains the intestinal absorption component of Nexlizet. LDL reduction ~15-20%. Widely available, inexpensive ($10-30/month generic), and well-tolerated. Appropriate bridge while awaiting Nexlizet supply.

Nexletol (bempedoic acid 180 mg): Same bempedoic acid component, though without ezetimibe. May be available at pharmacies that do not stock Nexlizet. Similar retail pricing.

PCSK9 inhibitors (evolocumab, alirocumab): For high-risk patients with ASCVD or HeFH who need >40% LDL reduction. Superior efficacy (~45-60% LDL reduction) but require subcutaneous injection, robust prior authorization documentation, and higher out-of-pocket costs without assistance programs.

Inclisiran (Leqvio): An siRNA-based PCSK9 inhibitor administered twice yearly. Excellent adherence profile but injectable, limited to specialist settings for administration, and restricted formulary coverage.

Helping Your Patients Access Nexlizet and Supporting Resources

medfinder offers a provider-facing solution for helping patients locate hard-to-find medications. Through medfinder for providers, your patients can submit their medication and location, and medfinder calls pharmacies on their behalf to identify which ones can fill the prescription. Results are texted directly to the patient.

Esperion's NEXSTEP Navigator program (navigator@esperion.com) provides access and prior authorization support for Nexlizet and Nexletol. The NEXSTEP Co-Pay Card can reduce patient out-of-pocket costs to as little as $10/fill for commercially insured patients. Samples are available to providers upon request.

For a patient-facing version of this availability update, see our Nexlizet shortage patient update.