Two routes to PBS-subsidised statin therapy — a qualifying clinical condition (any lipid level) or lipid levels above a threshold after a dietary trial. Ezetimibe is the usual escalation (Authority Streamlined) for statin failure or intolerance. Exact lipid-level cut-offs and the statin-intolerance definition are detailed — confirm current wording at pbs.gov.au.
1Eligibility — key pathways
✓Established CVD / atherosclerosis — Secondary prevention — IHD, stroke/TIA, PAD — qualifies at any lipid level.
✓High-risk clinical groups — Diabetes with age over 60 or microalbuminuria, confirmed FH, strong family history of premature CVD, or ATSI — lower thresholds apply.
✓Lipid-level pathway — No qualifying condition: 6-week dietary trial first, then fasting lipids above a PBS threshold that varies with HDL/BP/diabetes — confirm exact cut-off at pbs.gov.au.
✓Ezetimibe escalation — Statin failure or intolerance, FH, or high (>15% 5-year) CV risk. Authority required (Streamlined).
2Which statin
| Statin | Potency | Practical notes |
|---|
| Atorvastatin | High | Commonly first-line; established secondary-prevention/post-ACS evidence |
| Rosuvastatin | High | Among the most potent per mg; option if atorvastatin under-target |
| Simvastatin / pravastatin | Moderate | Simvastatin: more CYP3A4 interactions. Pravastatin: water-soluble, fewer interactions — consider in renal impairment |
Verify at PBS — Pathway-B lipid-level thresholds and the PBS statin-intolerance definition (CK and transaminase multiples) are detailed and not reproduced here — confirm exact figures at pbs.gov.au. LDL treatment targets are clinical guideline figures, not PBS criteria.
3Safety & exclusions
Safety
- Baseline LFTs & consider CK before starting; routine CK monitoring not required unless myalgia develops.
- Muscle symptoms are common and don't always need cessation — assess severity/CK before stopping.
- All statins contraindicated in pregnancy/breastfeeding.
Check / exclude
- Confirm exact PBS lipid thresholds & statin-intolerance definition at pbs.gov.au — not reproduced here.
- Active liver disease or unexplained persistent transaminase rise.
- FDCs (Atozet, Rosuzet) generally need components trialled first.
- PCSK9 inhibitors have their own pathway — see CV-03.
EN-06 v1.0 · Reviewed Jun 2026 · Review Dec 2026
For health-professional use. Eligibility and lipid thresholds summarised from public PBS reporting — confirm exact cut-offs at pbs.gov.au. LDL targets are guideline-aligned (not PBS).
