Many of the agents to treat hypercholesterolemia have become generically available. In recent years, newer targetted therapies have become available with different targets, higher prices and requiring clinician-administration. To understand how US managed care (MC) plans were using the various tools available to manage their formularies and members with hypercholesterolemia, hyperlipidemia and high trigylcerides. Managed care medical directors and pharmacy directors completed an online interactive survey. Topics included: advisor and plan information, copays and drug/treatment usage of different classes for cholesterol management (classifying as: Unrestricted,1st tier, 2nd tier, 3rd tier, or requiring prior authorization [PA]). Fifty-nine percent of respondents were MDs, with the remainder comprising mostly of pharmacists who largely worked for a health plan (62.3%). The health plans were 41.1% national, 30.4% regional, and 28.6% local. Plans could cover multiple types of members and 79.6% covered commercial lives, 61.1% Medicaid (low-income); 68.5% Medicare (the elderly). Responses identified the highest PA rates for: PSCK9s inhibitors (alirocumab and evolocumab)=84.62%, lomitapide=71.1%. Classes with generic options were often in the first tier and included statins=47.2%, triglycerides=33.3%; fibrates=29.4%. Combination cholesterol agents=44.2% and cholesterol/cardiovascular combinations=43.1% and were mostly in tier 2. While OTC fish-oil products and supplements were generally unrestricted in Medicaid plans, not covered by Commercial or Medicare plans; the prescription therapy icosapent was PA restricted by 17.3% of plans. The most common tier 2 products included ezetimibe (40.4%) followed by the bile-acid sequesterants (32.7%) of the time compared with fibrates. In addition to the cost of clinician-administration, PSCK9s will most likely be subject to a specialty copay and administered under the medical-benefit (64.3% of respondents), pharmacy-benefit (5.4%), or use the benefit based on plan-design or price-thresholds. As new products enter the cholesterol management market, health plans will likely impose restrictions and plan designs on new classes favoring less expensive generically available agents until real world effectiveness data becomes available.