Cardiovascular medicine is struggling with the new proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor drugs for lowering low-density lipoprotein cholesterol (LDL), not primarily because of efficacy concerns or safety issues, but because the price of these new agents exceeds $14 000 a year. While clinicians are seeking to understand how best to exploit the potential for enhanced protection these drugs may provide to patients at risk of atherosclerotic complications (such as myocardial infarction and stroke), payers are focused on constraining the use of these medications, recognizing that the pool of candidates for PCSK9 inhibitor drugs is enormous.