Season 3 Episode 1: Statin Monopoly and Hidden Gaps in Long Term Care

Andie Morataya

Welcome everyone to Season 3 of the Better Living Through Data podcast! We hope everyone had a wonderful break through the summer months. Anthony and I are excited to be back and talk about Life Sciences, Data and the Aging Population! So every September, Anthony, we see all these big public health campaigns for National Cholesterol Education Month, telling everyone to get their blood cholesterol checked, learn their bad LDL versus good HDL numbers, you know, take control of your heart health. But when you look at the actual electronic health record data from four hundred forty seven thousand eighty skilled nursing facility residents, the reality on the ground inside long term care is...um....it looks completely different.

Anthony Pero

Four hundred forty seven thousand residents is a massive sample, Andie. And what stands out immediately is that while eighty three point three percent of residents with a hyperlipidemia diagnosis do get a treatment order, statins account for an overwhelming ninety six point two percent of all active medication orders. Ninety six point two percent. It is basically a statin monopoly.

Andie Morataya

Ninety six point two percent! I mean, that is just incredible. And what about all the other American Heart Association recommended therapies? Like cholesterol absorption inhibitors, ezetimibe, or omega three fatty acids, or fibrates? They are barely even showing up.

Anthony Pero

They combine for less than eight percent of all orders. Less than eight percent. So if a resident cannot tolerate a statin, or if their lipid numbers need a second line agent, the data suggests those non statin options just are not getting ordered in post acute care. It raises a huge question about whether we are seeing deliberate clinical optimization or just pure clinical inertia in long term care settings.

Andie Morataya

Right! Because as a marketer, I look at September cholesterol campaigns and think, okay, public awareness is great, but awareness does not solve institutional barriers. If eighty three point three percent get treated, but almost everyone is defaulted straight onto a statin without considering non statin options, then all those public health messages about personalized lipid management are hitting a giant wall at the facility door.

Anthony Pero

Well, and from a payer and market access perspective, that statin default is deeply entrenched. Statins are generic, they are cheap, they are built into every clinical protocol and formulary tier. But when older adults in skilled nursing facilities need individualized care, relying solely on statin inertia means a lot of residents might not be reaching their therapeutic goals.

Andie Morataya

And it gets even more complicated when you look at who actually gets a treatment order. The researchers ran a modified Poisson regression model, and some of the risk ratios were, um, really eye opening.

Anthony Pero

Yeah, the co treatment numbers make clinical sense at first glance. Having an active hypertension medication order gave a risk ratio of one point one six, and a diabetes medication order was one point zero nine. Basically, if a physician is already treating high blood pressure or diabetes, they are more likely to order a lipid lowering drug. But then you look at sex and payer status.

Andie Morataya

That point zero nine for diabetes and one point one six for hypertension, sure, it shows physicians are stacking cardiovascular protections. But female sex had a risk ratio of zero point nine five. That means female residents in skilled nursing facilities were five percent less likely to have a lipid medication order compared to male residents. Why are women in long term care getting prescribed lipid therapy less often despite having clear cardiovascular risks?

Anthony Pero

That zero point nine five risk ratio reflects a broader problem we see in cardiology, where female cardiovascular risk often gets undertreated or underrecognized, even in frail older populations. But the payer numbers were equally striking. Private payer coverage had a risk ratio of zero point nine four, and other payer types dropped down to zero point eight seven, compared to standard coverage.

Andie Morataya

Zero point eight seven! So having private insurance or an alternative payer in a skilled nursing facility actually reduced the likelihood of getting a lipid medication order by thirteen percent? That sounds completely backwards!

Anthony Pero

It sounds counterintuitive, but private insurance structures in long term care often involve different formulary restrictions, prior authorization hurdles, or short term rehabilitation benefit designs that do not prioritize long term preventative cardiovascular pharmacotherapy. So while a resident is in the facility, those coverage structures can create unexpected friction for standard drug management.

Andie Morataya

So as we think about National Cholesterol Education Month, the takeaway here is that getting diagnosed or screened is only step one. Real progress means looking past that eighty three point three percent treatment rate and addressing why women face a zero point nine five risk ratio, why private payers drop ordering likelihood to zero point nine four, and why non statin alternatives sit below eight percent.

Anthony Pero

Exactly. True quality care in long term care requires moving beyond diagnostic screening toward equitable access, removing formulary barriers, and ensuring every resident gets personalized lipid treatment that actually fits their needs.

Andie Morataya

If you would like to learn more about our data, visit the link in today’s podcast description! Thanks for joining us back here on Season 3 of the Better Living Through Data podcast!

Anthony Pero

Thanks everyone! Catch you next week!