The PCSK9 inhibitors used to lower LDL cholesterol are far too expensive and are not cost effective, according to a new analysis. Using an annual cost of just over $14,000 per year (based on mean wholesale acquisition costs of evolocumab and alirocumab in 2015), the drugs were found to cost more than $500,000 per quality-adjusted life-year (QALY) for patients with familial hypercholesterolemia compared to standard care (statin + ezetimibe). For patients suffering from atherosclerotic cardiovascular disease, the cost was $414,000 per QALY. If PCSK9 inhibitors were used in all eligible U.S. patients, they would reduce cardiovascular care costs by $29 billion while increasing drug costs by $592 billion. The authors estimated that the manufacturers of these drugs would need to reduce the annual cost by nearly $10,000 per year, from $14,000 to about $4,500, to make them cost effective. (JAMA 2016;316:743-753)