Drugs, Health Technologies, Health Systems

Reimbursement Recommendation

Bempedoic Acid (Nilemdo)

Indication: Primary hyperlipidemia and cardiovascular disease

Sponsor: HLS Therapeutics Inc.

Final recommendation: Reimburse with conditions

Summary

What Is the Reimbursement Recommendation for Nilemdo?

Canada’s Drug Agency (CDA-AMC) recommends that Nilemdo be reimbursed by public drug plans for primary hyperlipidemia and cardiovascular disease (CVD), if certain conditions are met.

Why Did CDA-AMC Recommend Reimbursement?

The Canadian Drug Expert Committee (CDEC) determined that Nilemdo demonstrated acceptable clinical value versus ezetimibe in patients with primary hyperlipidemia and CVD. However, it was uncertain whether Nilemdo demonstrates acceptable clinical value versus alirocumab, evolocumab, or inclisiran in patients with primary hyperlipidemia and CVD. This determination was enough for CDEC to recommend that Nilemdo be reimbursed. Given that Nilemdo is expected to be an alternative lipid-lowering therapy, acceptable clinical value refers to at least comparable value versus lipid-lowering therapies other than statins.

Evidence from 1 clinical trial showed that Nilemdo, compared with placebo, reduced the risk of major cardiovascular events from happening (including death, heart attack that does not result in death, stroke that does not result in death, or surgical procedures that restore blood to parts of the heart) when given for a median follow-up of 3.4 years. This study included adults who had CVD and high levels of lipids in the blood, and who were unable to receive stable, recommended statin therapy. In those who were receiving the highest tolerated dose of statins, evidence from 2 clinical trials showed that 12 weeks of treatment with Nilemdo reduced low-density lipoprotein cholesterol (LDL-C) levels compared with placebo in the presence of CVD and high levels of lipids in the blood.

Evidence from an indirect treatment comparison showed that there was no clear difference between Nilemdo and ezetimibe for reducing LDL-C levels after 24 weeks of treatment, but that injectable lipid-lowering therapies (e.g., alirocumab, evolocumab, and inclisiran) were more effective than Nilemdo or ezetimibe at reducing LDL-C levels. The indirect treatment comparison included adults who had high levels of lipids in the blood and who had CVD or were at high risk of CVD, despite receiving stable, recommended statin therapy or being unable to receive recommended statin therapy.

Nilemdo may address an unmet need for treatment that reduces the risk of cardiovascular events in patients with high LDL-C levels who are at high risk of CVD, and who are either unable to receive stable, recommended statin therapy, or who are already receiving the highest tolerated dose of statins.

Based on all of the preceding considerations, CDEC recommended that Nilemdo be reimbursed.

Which Patients Are Eligible for Coverage?

Nilemdo should only be covered for adults with a history of CVD or at high risk of CVD and who have elevated LDL-C levels.

What Are the Conditions for Reimbursement?

Nilemdo should be initially covered for 3 months and may be continued if the patient shows a meaningful reduction in LDL-C of at least 10% from before treatment began with Nilemdo, and the cost of Nilemdo does not exceed the drug program cost of ezetimibe.

Important budget impact considerations must be addressed for health systems to be able to adopt Nilemdo.

Review Background

Highlights of Input From Interested Parties

The patient group (HeartLife Foundation) noted the following regarding impacts of the disease, unmet needs, and important outcomes:

The clinician groups (Riverside Cardiology and Diagnostic Imaging; Total Cardiology Rehabilitation; key opinion leaders in the management of cardiovascular risk factors; Collaborative CME and Research Network; Oakville Cardiologists; Saskatchewan Cardiologists; and St. Michael’s Hospital, Unity Health Toronto, and University of Toronto) and the clinical experts consulted by CDA-AMC noted the following regarding unmet needs arising from the disease and place in therapy for the drug under review:

The participating public drug programs raised potential implementation issues related to considerations for initiation, discontinuation, and prescribing of therapy; care provision issues; and system and economic issues.

Recommendation

With a vote of 13 in favour to 0 against, CDEC recommends that bempedoic acid be reimbursed for primary hyperlipidemia and CVD, only if the conditions listed in Table 1 are met.

Table 1: Reimbursement Conditions and Reasons

Reimbursement condition

Reason

Implementation guidance

Initiation

1. Adult patients with a history of ASCVD or at high risk of CVD

2. Who have elevated LDL-C levels, defined as either of the following:

2.1. LDL-C ≥ 2.6 mmol/L in patients who have had an adequate trial with at least 2 statins and are unable to receive stable, recommended statin therapy due to intolerance

2.2. LDL-C ≥ 1.8 mmol/L in patients who are receiving a stable, optimized lipid-lowering background therapy of an effective statin dose.

The 2021 Canadian Cardiovascular Society dyslipidemia guidelines recommend a stepwise, LDL-C level target-driven approach starting with lifestyle modification and maximally tolerated statin therapy.

Evidence from the CLEAR Outcomes study demonstrated that treatment with bempedoic acid resulted in added clinical benefit in terms of cardiovascular outcomes and LDL-C reduction for adults who had a baseline LDL-C level of at least 2.6 mmol/L, had a history of or were at high risk for CVD, and were intolerant to statin therapy.

Evidence from the CLEAR Harmony and CLEAR Wisdom studies demonstrated that treatment with bempedoic acid resulted in added clinical benefit in terms of LDL-C reduction for adults who had a baseline LDL-C level of at least 1.8 mmol/L, high cardiovascular risk, and were receiving stable, maximally tolerated statin therapy.

History of CVD: In the CLEAR Outcomes study, a documented history of CVD was defined as coronary artery disease, symptomatic peripheral artery disease, and cerebrovascular disease.

High risk of CVD: Based on clinical expert input, CDEC considered that high risk of CVD may be defined as per the 2021 Canadian Cardiovascular Society dyslipidemia guidelines, which is consistent with what is being used in clinical practice in Canada. Currently, these guidelines state that high-risk primary prevention conditions warranting lipid-lowering therapy with a statin include most patients with diabetes, those with chronic kidney disease, and those with an LDL-C ≥ 5.0 mmol/L or a diagnosis of familial hypercholesterolemia.

Intolerance to statin therapy: In the CLEAR Outcomes study, an intolerance to statin therapy was defined as having an adverse effect that began or worsened with statin therapy and resolved or improved upon statin discontinuation. An intolerance to statin therapy was considered when there was an intolerance to 2 or more statins at any dose, or 1 statin at any dose and the patient was unwilling or advised not to try a second statin.

Based on clinical expert input, CDEC noted that the definition for an intolerance to statin therapy used in the CLEAR Outcomes study was acceptable and similar to that used in practice. CDEC noted that it would be acceptable that an intolerance to statin therapy for bempedoic acid be defined as per the reimbursement criteria of each public drug plan for drugs used for the treatment of hyperlipidemia and CVD in patients with an intolerance to statin therapy.

LDL-C threshold for initiation of bempedoic acid: The LDL-C ≥ 2.6 mmol/L threshold in patients with an intolerance to statin therapy is based on evidence from the CLEAR Outcomes study. However, CDEC acknowledged clinician input that the CLEAR Outcomes study design does not align with clinical practice in Canada. As such, public drug plans may consider using an LDL-C threshold of 1.8 mmol/L (i.e., the same as in patients who are receiving a stable, optimized statin dose) as per the 2021 Canadian Cardiovascular Society dyslipidemia guidelines. Based on these guidelines, where the LDL-C threshold used is ≥ 1.8 mmol/L, public drug plans may also determine treatment eligibility using non-HDL-C ≥ 2.4 mmol/L, or ApoB ≥ 0.7 g/L.

Criteria alignment: Eligibility for bempedoic acid may be based on the criteria used by each of the public drug plans for reimbursement of ezetimibe for hypercholesterolemia. There is insufficient evidence that bempedoic acid is clinically superior to ezetimibe (currently reimbursed for hypercholesterolemia) and they occupy a similar place in therapy; therefore, there is no evidence that bempedoic acid should be held to a different standard than ezetimibe when considering initiation in patients with hyperlipidemia and CVD.

3. Duration of initial authorization is 12 weeks.

In the CLEAR Harmony and Wisdom studies, the change from baseline in LDL-C levels was assessed at 12 weeks.

CDEC recognized that access to appropriate prescribers may be limited in some jurisdictions, and delays in assessment may exceed typical initial authorization timelines. Therefore, public drug plans may consider extending the initial authorization period (e.g., up to 6 months) to accommodate these constraints and ensure equitable access.

Renewal

4. For renewal after initial authorization, the physician must provide proof of clinical response to therapy, defined as a reduction of LDL-C levels of at least 10%.

CDEC considered the magnitude of the benefits observed in the trials. In the CLEAR Harmony and Wisdom studies, the differences between groups for relative LDL-C level reduction at 12 weeks were –18.1% (95% CI, –20.0% to –16.1%) and –17.4% (95% CI, –21.0% to –13.9%), respectively. In the CLEAR Outcomes study, the difference between groups for relative LDL-C level reduction at 6 months was –20.3% (95% CI, –21.1% to –19.5%). Therefore, the renewal condition is to ensure that bempedoic acid is reimbursed in patients who benefit from the treatment.

Renewal after initial authorization may be based on the criteria used by each of the public drug plans for reimbursement of ezetimibe for hypercholesterolemia. There is no evidence that bempedoic acid should be held to a different standard than ezetimibe when considering renewal in patients with hyperlipidemia and CVD.

Pricing

5. The drug program cost of bempedoic acid should be negotiated so that it does not exceed the drug program cost of ezetimibe.

Based on the committee’s assessment of the evidence, bempedoic acid is expected to have similar clinical benefits and harms compared with ezetimibe.

Although bempedoic acid plus ezetimibe may lead to an increased benefit compared with ezetimibe, the committee is unable to issue a pricing condition based on the sponsor’s economic evaluation due to the substantial limitations with the comparative evidence.

Therefore, the drug program cost of bempedoic acid should be no more than ezetimibe.

Feasibility of adoption

6. The economic feasibility of adoption of bempedoic acid must be addressed.

At the submitted price, the incremental budget impact of bempedoic acid is expected to be greater than $40 million in years 2 and 3, and the magnitude of uncertainty in the budget impact must be addressed to ensure the feasibility of adoption, given the difference between the sponsor’s estimate and the CDA-AMC estimate(s).

ASCVD = atherosclerotic cardiovascular disease; CDA-AMC = Canada’s Drug Agency; CDEC = Canadian Drug Expert Committee; CI = confidence interval; CVD = cardiovascular disease; LDL-C = low-density lipoprotein cholesterol.

Rationale for the Recommendation

Clinical Value

Based on the totality of the clinical evidence, CDEC concluded that bempedoic acid demonstrates acceptable clinical value compared with ezetimibe in patients with primary hyperlipidemia and CVD. However, it was uncertain whether bempedoic acid demonstrates acceptable clinical value versus alirocumab, evolocumab, or inclisiran in patients with primary hyperlipidemia and CVD. Given that bempedoic acid is expected to be an alternative to LLTs other than statins, acceptable clinical value refers to at least comparable value versus LLTs other than statins.

Evidence from 1 placebo-controlled randomized controlled trial (RCT) (CLEAR Outcomes; N = 13,970) showed that treatment with bempedoic acid resulted in added clinical benefit compared with placebo for adults with primary hyperlipidemia and CVD who are intolerant to stable, recommended statin therapy. After a median follow-up of 3.4 years, bempedoic acid reduced the risk of 4-component major adverse cardiovascular event (MACE), which included cardiovascular death, nonfatal myocardial infarction (MI), nonfatal stroke, or coronary revascularization; the hazard ratio was 0.87 (95% confidence interval [CI], 0.79 to 0.96). CDEC noted that the effect of bempedoic acid was mostly driven by reductions in nonfatal MI and coronary revascularization events, while there was the possibility of no important difference in the risk of nonfatal stroke, cardiovascular death, or all-cause mortality. The treatment effect for bempedoic acid was less certain for other cardiovascular outcomes that did not include coronary revascularization, such as the risk of 3-component MACE, fatal or nonfatal MI, fatal or nonfatal stroke, and risk of cardiovascular death, due to serious imprecision.

Two placebo-controlled RCTs (CLEAR Harmony; N = 2,230 and CLEAR Wisdom; N = 779) showed that treatment with bempedoic acid resulted in a clinically meaningful reduction in LDL-C levels for adults with primary hyperlipidemia and CVD who are receiving maximally tolerated statins. After 12 weeks of treatment, the difference between groups for relative LDL-C level reduction was 18.1% (95% CI, –20.0% to –16.1%) in the CLEAR Harmony study and –17.4% (95% CI, –21.0% to –13.9%) in the CLEAR Wisdom study. However, there is no direct evidence provided in the submission materials for the effect of bempedoic acid on cardiovascular outcomes in patients who are receiving maximally tolerated statins.

The indirect evidence from a network meta-analysis (NMA) of bempedoic acid versus other LLTs that are not statins suggested that there was no clear difference in LDL-C level reduction between bempedoic acid and ezetimibe, and that PCSK9 inhibitors were favoured over either bempedoic acid or ezetimibe monotherapy at 24 weeks. However, these results were uncertain due to imprecision and methodological limitations. Results for 52 weeks of treatment were inconclusive due to indirectness, heterogeneity, and imprecision. Because of the limited evidence, CDEC could not make conclusions on the comparative efficacy and safety of combination therapy with bempedoic acid and other LLTs that are not statins; the evidence for combination of bempedoic acid and ezetimibe included a small number of patients and pertained to LDL-C level reductions, while the combination of bempedoic acid and PCSK9 inhibitors was not properly assessed.

Bempedoic acid may address an unmet need for treatment that reduces the risk of cardiovascular events in patients with elevated LDL-C levels who are at high risk of CVD, and who are either unable to receive stable, recommended statin therapy due to intolerance, or who are receiving maximally tolerated statin therapy.

Further information on the committee’s discussion around clinical value is provided in the Summary of Deliberation section.

Developing the Recommendation

The determination of acceptable clinical value was sufficient for CDEC to recommend reimbursement of bempedoic acid. As part of the deliberation on whether to recommend reimbursement, the committee also considered unmet clinical need, unmet nonclinical need, and health inequity. Information on this discussion is provided in the Unmet Clinical Need and Distinct Social and Ethical Considerations domains in the Summary of Deliberation section.

Because CDEC recommended that bempedoic acid be reimbursed, the committee also deliberated on whether reimbursement conditions should be added to address important economic considerations, health system impacts, or social and ethical considerations, or to ensure clinical value is realized. The resulting reimbursement conditions, with accompanying reasons and implementation guidance, are stated in Table 1.

Summary of Deliberation

CDEC considered all domains of value of the deliberative framework before developing its recommendation: clinical value, unmet clinical need, distinct social and ethical considerations, economic considerations, and impacts on health systems. For further information on the domains of value, refer to Expert Committee Deliberation at Canada’s Drug Agency.

The committee considered the following key discussion points, organized by the 5 domains of value.

Clinical Value

Unmet Clinical Need

Distinct Social and Ethical Considerations

Economic Considerations

CDEC in particular noted the uncertainty associated with the analysis of bempedoic acid plus ezetimibe and that this was informed by studies with small sample sizes. CDEC agreed that the results of the indirect evidence were uncertain, and thus the results of the economic evaluation were uncertain.

Impacts on Health Systems

CDEC noted the incremental budget impact of reimbursing bempedoic acid is predicted to be greater than $40 million in year 2 and year 3, and the economic feasibility of adoption must be addressed. CDEC also noted the magnitude of uncertainty in the budget impact must be addressed to ensure the feasibility of adoption, given the difference between the sponsor’s estimate and the CDA-AMC estimate.

Sources of Information Used by the Committee

To make its recommendation, the committee considered the following information (links to the full documents for the review can be found on the project webpage):

CDEC Information

Members of the Committee

Dr. Peter Jamieson (Chair), Dr. Kerry Mansell (Vice-Chair), Sally Bean, Daryl Bell, Dan Dunsky, Dr. Ran Goldman, Dr. Trudy Huyghebaert, Dr. Dennis Ko, Dr. Christine Leong, Alicia McCallum, Dr. Srinivas Murthy, Dr. Nicholas Myers, Dr. Krishnan Ramanathan, Dr. Marco Solmi, Carla Velastegui, Dr. Edward Xie, and Dr. Peter Zed.

Meeting date: May 28, 2026

Regrets: None

Conflicts of interest: Two expert committee members did not participate due to considerations of conflict of interest.