Short answer
No Lp(a)-lowering drug is FDA-approved yet, and none is likely before the outcome trials report. The registered completion dates are 2028 for olpasiran, 2029 for lepodisiran, and 2031 for muvalaplin. If your Lp(a) is high now, the plan is to lower LDL and ApoB further with medicines that are already approved.
Several drugs that target Lp(a) directly are in large outcome trials, and obicetrapib, a new pill that lowers LDL cholesterol (LDL-C), is under review in Europe. None is FDA-approved yet. In September 2026, the first Lp(a) drug to finish an outcomes trial, pelacarsen, lowered Lp(a) but didn't reduce heart attacks and strokes, so the big question for this class is still open.
What new cholesterol treatments are being developed beyond current options?
Lp(a) is high in roughly 1 in 5 people, is mostly inherited, and still has no medicine approved to lower it directly (see our full guide on Lp(a)). A drug that safely cuts Lp(a) and prevents heart attacks would fill a gap. The trials below will show whether that's possible.
When will Lp(a) drugs be available?
Not before their outcome trials report, which is likely years away. ClinicalTrials.gov lists estimated completion dates of March 2028 for olpasiran, March 2029 for lepodisiran, and March 2031 for muvalaplin. Zerlasiran had not reported starting an outcomes trial as of August 2026.
None of the investigational medications below are FDA-approved or available by prescription. This section tracks drugs still in the pipeline. Two newer PCSK9 inhibitors that have reached the market, the once-monthly injection Lerochol (available since May 2026) and the daily pill Lipfendra (approved July 2026), are covered in their own guides.
What happened with pelacarsen?
It lowered Lp(a) but missed its main goal. On September 4, 2026, Novartis announced that the Lp(a)HORIZON trial, which enrolled 8,323 people with heart disease and high Lp(a), did not show a significant reduction in cardiovascular events with pelacarsen compared with placebo. Full results are expected at an upcoming medical meeting.
Pelacarsen is an antisense drug, a different technology from the siRNA drugs below. Their own outcome trials will test whether those drugs, which lowered Lp(a) by more than 90% in some early-trial patients, prevent heart attacks and strokes. (Novartis announcement, SEC filing, September 2026)
Which Lp(a) drugs are still in trials?
Three siRNA injections and one pill are in, or ready for, large outcome trials. siRNA (small interfering RNA) tells the liver to make less of the protein Lp(a) is built from.
- Olpasiran (Amgen). Its phase 3 OCEAN(a)-Outcomes trial enrolled 7,297 people with heart disease and high Lp(a), and is listed with an estimated completion date of March 2028 (ClinicalTrials.gov NCT05581303). In phase 2, higher doses lowered Lp(a) by more than 95%, and at one dose it was still about 44% below baseline nearly a year after the last injection.
- Lepodisiran (Eli Lilly). In the phase 2 ALPACA trial, a single high dose lowered Lp(a) by about 94% over six months. Its phase 3 outcomes trial, ACCLAIM-Lp(a), is listed with an estimated completion date of March 2029 (NCT06292013).
- Zerlasiran (Silence Therapeutics). In the phase 2 ALPACAR-360 trial, Lp(a) fell by about 81 to 86% on average over 36 weeks compared with placebo, depending on the dose. The company completed its phase 3 preparation in 2025 but, as of August 2026, had not reported starting an outcomes trial.
Source
O'Donoghue ML, Rosenson RS, López JAG, et al. “The Off-Treatment Effects of Olpasiran on Lipoprotein(a) Lowering: OCEAN(a)-DOSE Extension Period Results.” Journal of the American College of Cardiology (2024).
View paperSource
Nissen SE, Ni W, Shen X, et al. “Lepodisiran: A Long-Duration Small Interfering RNA Targeting Lipoprotein(a).” New England Journal of Medicine (2025).
View paperSource
Nissen SE et al. “Zerlasiran: A Small-Interfering RNA Targeting Lipoprotein(a): A Phase 2 Randomized Clinical Trial.” JAMA (2024).
View paperWhat is muvalaplin, and is it available in 2026?
Muvalaplin is not available in 2026. It is a daily pill from Eli Lilly that blocks Lp(a) particles from assembling. In the phase 2 KRAKEN trial, it lowered Lp(a) by up to about 70 to 86% at 12 weeks compared with placebo, depending on the lab method used, and lowered ApoB by up to about 16%. Its phase 3 outcomes trial, MOVE-Lp(a), started in September 2025 and is listed with an estimated completion date of March 2031 (NCT07157774). If it succeeds, it would be the first pill made specifically to lower Lp(a).
Source
Nicholls SJ et al. “Oral Muvalaplin for Lowering of Lipoprotein(a): A Randomized Clinical Trial.” JAMA (2025).
View paperObicetrapib: an oral option for LDL
Obicetrapib (NewAmsterdam Pharma) is a once-daily CETP inhibitor pill aimed mainly at lowering LDL. Earlier drugs in this class mostly disappointed, and one caused harm (see our HDL guide for that history). Obicetrapib has completed its phase 3 LDL-lowering trials, which are the basis for its applications in Europe.
As of May 2026, the company expected European, UK, and Swiss regulatory decisions in the second half of 2026, both alone and combined with ezetimibe. Its cardiovascular outcomes trial, PREVAIL, enrolled 9,541 people, with an interim analysis planned for late 2026 and results expected in early 2027. It is not FDA-approved. (NewAmsterdam Pharma, SEC filing, May 2026)
Will insurance cover an Lp(a) drug once one is approved?
Nobody can know yet. No Lp(a)-lowering drug has FDA approval, so no plan has written a coverage policy, and a plan decides coverage only after approval and a label exist. Any price or coverage claim before then is a guess, and this guide makes none.
What you can do now is build the paper trail a future request would use. Keep your Lp(a) result with its date and units, your LDL and ApoB results, and a record of the medicines you have taken. If a plan denies a drug after approval, you can ask your clinician to file an appeal with those records. Start from the plan's written denial letter.
Can you get an Lp(a) drug before it is approved?
Possibly, through a clinical trial or an expanded access request, and only if you fit the entry rules. ClinicalTrials.gov lists recruiting phase 3 studies of olpasiran and lepodisiran, including OCEAN(a)-PreEvent, an olpasiran trial in people without a prior cardiovascular event with a listed completion date of October 2031 (NCT07136012). It also lists an Amgen expanded access program for olpasiran, which says requests may be considered for adults with high Lp(a) and atherosclerotic cardiovascular disease, with requests going to Amgen's call center (NCT07079267, checked October 2026). Ask your clinician whether either route fits your situation, and search ClinicalTrials.gov for studies near you.
What should you do if your Lp(a) or LDL is high today?
Step by step
Act on a high Lp(a) today, step by step
- Time
- About 15 minutes to start
Get Lp(a) and ApoB measured
Standard panels miss both. Our advanced lipid testing page explains how we measure them.
Set an LDL and ApoB goal with a clinician
With a high Lp(a), the plan is to lower LDL and ApoB further than you otherwise would.
Review the approved medicines
Statins, ezetimibe, and when needed a PCSK9 inhibitor such as Repatha, Praluent, Lerochol, or Lipfendra can all lower LDL now.
Recheck your numbers and adjust
Repeat labs on your clinician's schedule and change the plan until you reach goal.
If your Lp(a) is high, the plan today is to lower LDL and ApoB further than you otherwise would, using medications that are already approved: statins, ezetimibe, and when needed a PCSK9 inhibitor such as Repatha, Praluent, Lerochol, or Lipfendra. See who qualifies on our PCSK9 inhibitor prescription page, and our advanced lipid testing page for how we measure Lp(a) and ApoB.
If one of these drugs is approved and shown to prevent events, it would add to that plan. Waiting for it delays protection you can get today.
Summary
The Lp(a) pipeline took a setback with pelacarsen, and the siRNA drugs and muvalaplin still have to prove they prevent heart attacks and strokes, with results expected from 2028 onward. At Preval Health, our protocols track this pipeline so treatment plans can change when the evidence does. In the meantime, the plan stays the same: lower LDL and ApoB with medicines that are already approved.