[New rules on hypolipidemic drug reimbursability in Italy]

The Italian National Committee for Drugs (CUF) has recently reviewed the reimbursement criteria for hypolipidemic drugs in our country. The new rules allow the reimbursement of statins and fibrates in patients with familial dyslipidemias, and of statins in hypercholesterolemic subjects who are not responders to an appropriate diet and are at high risk of a first major cardiovascular event, or already affected by coronary heart disease. To evaluate the level of coronary risk, the new document suggests to use risk algorithms or risk charts. The use of the risk charts recently published by the European Societies of Cardiology, Hypertension and of Atherosclerosis, and based on the Framingham algorithm, is suggested for risk grading of patients without clinically overt coronary heart disease. For coronary patients, the risk chart based on the follow-up of the cohort of the Italian GISSI-Prevenzione study should be used. Therefore, the reimbursement of statins will no longer be linked, according to this document, to cholesterol plasma levels, but rather to a specific level of coronary risk. By following these guidelines, the theoretical ground for a more appropriate use of these drugs, also characterized by a more favorable cost-benefit ratio, is established. Even if some aspects of the CUF document may need revision or clarification, it can be envisaged that it will favorably impact on the quality of cardiovascular prevention in our country.