New Cholesterol Drugs 2026: Pill, Monthly and Twice-Yearly Shots

Last updated October 2026

2026 brought a daily PCSK9 inhibitor pill called Lipfendra, a once-a-month shot called Lerochol, and a wider label for Leqvio, a twice-a-year shot you can now use without a statin. The 2026 US cholesterol guideline also changed how these drugs are used: it sets clear goals for LDL cholesterol (LDL-C) and says to add a non-statin without delay when you're above yours.

This guide shows people who already know their numbers which drugs they can actually get. Some headline drugs you may have read about are still in trials, and we mark those clearly.

What are the newest cholesterol medications in 2026?

Three are new or newly expanded: Lipfendra (approved July 2026), Lerochol (launched May 2026), and Leqvio, whose label now allows use on its own. All three work on PCSK9, a liver protein that destroys the receptors your liver uses to pull LDL out of the blood.

Blocking PCSK9 leaves more of those receptors working, so more LDL gets cleared. Repatha and Praluent have done this for about a decade. The new versions come as a pill, a monthly shot, and a twice-a-year shot. Our PCSK9 inhibitors guide explains the class in more depth.

Enter your LDL and goal to see what each medicine could do on average.

Is there a new cholesterol pill?

Yes. Lipfendra (enlicitide), made by Merck, is the first PCSK9 inhibitor you take by mouth, and the FDA approved it in July 2026 for adults with high cholesterol, including heterozygous familial hypercholesterolemia (prescribing information, DailyMed). In its phase 3 trials it lowered LDL by about 56 to 59% more than placebo, in the same range as the injections.

You take one 20 mg tablet in the morning on an empty stomach, then wait at least 30 minutes before food. Merck set the list price at $10.50 a day, about $315 a month (Chicago Sun-Times). Its heart-outcomes trial, CORALreef Outcomes, is still running (ClinicalTrials.gov NCT06008756). Our Lipfendra guide covers dosing and side effects.

If "new cholesterol pill" makes you think of something smaller, consider the combination pills. Nexlizet combines bempedoic acid and ezetimibe in one daily tablet and lowered LDL by 38% more than placebo in its label trial (Nexlizet prescribing information, DailyMed). Nexlizet has been around since 2020, but the 2026 guideline moved bempedoic acid up to a first-line non-statin option, so clinicians now reach for it earlier. More in our Nexletol and Nexlizet guide.

Is there a new monthly injection for cholesterol?

Yes. Lerochol (lerodalcibep) is a once-a-month PCSK9 inhibitor you inject at home. The FDA approved it in December 2025, and in its year-long trial it lowered LDL by 56% more than placebo (TCTMD).

LIB Therapeutics launched it in the US on May 11, 2026 as a prefilled syringe that can stay at room temperature for up to three months, with a direct-to-patient cash price of $199 a month (LIB Therapeutics). The FDA approved an autoinjector pen on August 17, 2026, which the company expects to be available by January 2027 at the same price (LIB Therapeutics). No Lerochol-specific outcomes trial has reported yet. See our Lerochol guide.

Two older shots also changed:

• Leqvio (inclisiran), given by a healthcare professional twice a year after the first two doses, had its label updated in July 2025. It's now indicated alongside diet and exercise for adults with high cholesterol, with no requirement to be on a statin first (Leqvio prescribing information, DailyMed). Its outcomes trials haven't reported. Our Leqvio guide has the details.
• Repatha (evolocumab) gained new evidence. In VESALIUS-CV, reported in November 2025, it lowered the risk of a first heart attack, stroke, or coronary death by 25% in 12,257 people with atherosclerosis or diabetes who had never had a heart attack or stroke.

For a side-by-side of every shot, see our cholesterol shots guide.

How do the new options compare? Leqvio vs Nexlizet and the rest

The PCSK9 options all lower LDL by roughly half or more and differ mainly in how often you take them. After a statin, Leqvio is a twice-a-year clinic shot (about 50% in its trials) and Nexlizet is a daily pill (38% in its label trial), so the choice comes down to how much LDL you need to lose and whether you prefer a pill or a shot. Among them, only Repatha and Praluent have finished outcomes trials. Price and coverage often decide the rest.

Sources: the labels and trials linked above; Leqvio's figure is from ORION-10 and ORION-11 (Ray, NEJM 2020); Repatha's cash price is from Amgen's AmgenNow announcement. Praluent, the other established PCSK9 shot, is $225 a month self-pay through GoodRx (see our Praluent guide). These numbers come from different trials with different patients, so use them as ballpark figures for rough comparison.

What are non-statin cholesterol drugs, and what changed in the 2026 guideline?

Non-statin options include ezetimibe, PCSK9 inhibitors, and bempedoic acid. The 2026 ACC/AHA multisociety dyslipidemia guideline, published in March 2026, brought back specific LDL goals and tells clinicians to add a non-statin without delay when you're above goal. For people with heart disease, the goal is an LDL-C under 70 mg/dL, and under 55 for those at very high risk.

When LDL stays above goal on a statin, the guideline says adding ezetimibe and/or a PCSK9 inhibitor "should be implemented without delay," notes that PCSK9 inhibitors lower LDL by about 60% compared with 15 to 20% for ezetimibe, elevates bempedoic acid to a first-line non-statin option, and describes inclisiran as "a valuable alternative for select patients requiring durable LDL-C lowering" (ACC). It also lets clinicians choose among ezetimibe, PCSK9 inhibitors, and bempedoic acid based on the patient, with no fixed sequence.

In practice, you spend fewer months waiting on a drug that isn't getting you to goal. Insurance policies often lag behind guidelines, so paperwork still matters. Our guide on how low your LDL should be lists the goals by risk group.

Which new cholesterol drugs are still in trials?

Obicetrapib, the Lp(a)-lowering drugs, and gene editing are all still investigational in the US. None of them can be prescribed today.

• Obicetrapib (NewAmsterdam Pharma) is a once-daily CETP inhibitor pill aimed at LDL. As of May 2026, the company expected regulatory decisions in Europe, the UK, and Switzerland in the second half of 2026, with results from its PREVAIL outcomes trial expected in early 2027. It is not approved in the US (NewAmsterdam Pharma, SEC filing).
• Lp(a) drugs. No drug is approved specifically to lower Lp(a). On September 4, 2026, Novartis reported that pelacarsen lowered Lp(a) but missed its primary endpoint of reducing cardiovascular events in the Lp(a)HORIZON trial (Novartis, SEC filing). Olpasiran, lepodisiran, zerlasiran, and the pill muvalaplin are in separate trials, covered in our emerging therapies guide.
• Gene editing. VERVE-102 is a one-time IV infusion that uses base editing to switch off the PCSK9 gene in the liver. As of October 2026, a phase 1b study in people with familial hypercholesterolemia or early coronary disease is recruiting (ClinicalTrials.gov NCT06164730), and a placebo-controlled phase 2 study is listed as not yet recruiting (NCT07839936). It's years from approval, if it gets there.

If your Lp(a) is high today, lower your LDL and ApoB with what's already approved. Our Lp(a) guide explains why.

Should you switch to a newer cholesterol drug?

Only if your current plan isn't getting you to goal, or you can't tolerate it. Statins are inexpensive, have decades of outcomes data, and remain the base of treatment for most people under the 2026 guideline.

The newer drugs earn their place in a few situations:

• Your LDL or ApoB is still above goal on a statin, with or without ezetimibe
• You've had side effects on statins, or you'd rather not take one and accept a higher cost
• You have familial hypercholesterolemia and need a large drop
• You hate needles (Lipfendra) or want fewer shots (Lerochol monthly, Leqvio twice a year)

If outcomes evidence matters most to you, Repatha and Praluent are the PCSK9 options with completed outcomes trials. The newer ones are approved on LDL lowering, which is strongly linked to fewer heart attacks, but their own outcomes trials are pending or not yet started.

How do you get the new cholesterol medications? Switch or add a medicine step by step

You need a prescription from a licensed clinician, plus either insurance approval (usually a prior authorization) or a cash route. Lerochol and Repatha both have direct cash programs, and Lipfendra can be filled at a pharmacy's cash price.

Preval Health focuses only on prescription cholesterol care. A board-certified preventive cardiologist writes our treatment protocols, and licensed clinicians prescribe through our partner telehealth network. Our partner clinicians prescribe Repatha, Praluent, Lerochol, and Lipfendra. We're working with infusion centers to offer Leqvio, so ask us about availability in your area.

Preval runs as a cash practice. Prescriptions go through manufacturer direct programs, such as Lerochol at $199 a month, so you skip the insurance wait.

We order the labs that matter (LDL, ApoB, and Lp(a)) and recheck every quarter, adjusting to reach goal and keep you there. Care costs $99 a month, with medicines at cash prices. For the step-by-step version, see how to get a PCSK9 inhibitor prescription online.