Lead Author's Financial Disclosures Nothing to disclose. Study Funding National Heart, Lung, and Blood Institute. Background/Synopsis Familial hypercholesterolemia (FH) is an underdiagnosed and undertreated genetic condition that results in premature cardiovascular disease. Barriers and facilitators to caring for individuals with FH exist, however, research is limited on the extent to their impact on care delivery. Objective/Purpose To determine prevalence of barriers and facilitators documented in the literature related to three aspects of FH care: identification, cascade testing, and treatment. Methods The PubMed database was searched from inception to December 1, 2021, using the following search strategy: ``familial hypercholesterolemia'' and (``barriers'' OR ``enablers'' OR ``facilitators''). Eighty-six articles were returned. Articles not mentioning barriers or facilitators, and those that were not relevant to FH, non-English, or animal studies were excluded during abstract screening. Protocol papers were excluded during full-text screening. Results Forty-six of the 86 articles (53.5%) met inclusion criteria after screening. Of these, 26 were original research, 13 were reviews, and 7 were commentaries. Upon assessment of the barriers and facilitators reported, 41% (19/46) were determined to be related to treatment only, 17% (8/46) to identification only, 15% (7/46) to cascade testing only, and 26% (12/46) were some combination of two or more aspects of care. Cost was the most prevalent barrier to FH care discussed, reported in 65% (30/46) of the articles. Other barriers included general gaps in knowledge about FH care (14/46), limited access to specialists (8/46), competing health and life priorities (6/46), and non-adherence to and/or prior authorization requirements for medication therapies (11/46). The most common facilitators discussed in the literature included access to resources (2/46), health insurance coverage for genetic testing (2/46), and assistance with the medication prior authorization process (2/46), and those that were not relevant to FH. Conclusions There is substantial literature on the barriers and facilitators to FH care that can help inform interventions. Considerable overlap among barriers and facilitators exists across all three aspects of FH care. Future interventions should target barriers reported across several studies or address combinations of identification, cascade testing, and treatment. Likewise, facilitators that have positively impacted multiple aspects of FH care should be promoted and incorporated into care delivery. Nothing to disclose.