At mid-2018 list prices, PCSK9 inhibitors have a low cost value (>$150000 per quality-adjusted life-year) compared to good cost value (<$50000 per quality- adjusted life-year). Value Statement: Low Value (LOE: B-NR) Statement unchanged from 2018 Cholesterol Guidelines. In patients with clinical ASCVD who are on maximally tolerated statin therapy and are judged to be at very high risk and have an LDL-C level of 70 mg/dL or higher ( 1.8 mmol/L), it is reasonable to add ezetimibe therapy. IIa B-R Recommendation unchanged from 2018 Cholesterol Guidelines. In patients older than 75 years of age with clinical ASCVD, it is reasonable to initiate moderate- or high-intensity statin therapy after evaluation of the potential for ASCVD risk reduction, adverse effects, and drug drug interactions, as well as patient frailty and patient preferences. IIa B-R Recommendation unchanged from 2018 Cholesterol Guidelines. In patients older than 75 years of age who are tolerating high-intensity statin therapy, it is reasonable to continue high-intensity statin therapy after evaluation of the potential for ASCVD risk reduction, adverse effects, and drug-drug interactions, as well as patient frailty and patient preferences. IIa C-LD Recommendation unchanged from 2018 Cholesterol Guidelines. In patients with clinical ASCVD who are receiving maximally tolerated statin therapy and whose LDL-C level remains 70 mg/dL or higher ( 1.8 mmol/L), it may be reasonable to add ezetimibe. IIb B-R Recommendation unchanged from 2018 Cholesterol Guidelines. *Clinical ASCVD includes acute coronary syndrome, those with history of MI, stable or unstable angina, or coronary or other arterial revascularization, stroke, TIA, or peripheral artery disease, including aortic aneurysm, all of atherosclerotic origin. For high-intensity statin therapy, the 2018 ACC/AHA Cholesterol Guidelines recommend atorvastatin 80 mg daily or rosuvastatin 20 mg daily. Please refer to these guidelines for contraindications to high-intensity statin therapy and recommendations for moderate-intensity statin therapy. 