Understanding hyperlipidaemia, what it costs, and what your medical aid covers.
At a Glance
| Medical name | Hyperlipidaemia / Dyslipidaemia |
| ICD-10 code | E78 |
| What it is | Elevated blood fats — cholesterol (LDL, total) and/or triglycerides |
| How common | ~76.7% of SA adults with comorbidities; elevated triglycerides most prevalent |
| Chronic Disease List | CDL 006 — all schemes must fund statin therapy at PMB level |
| Typical first medication | Simvastatin 20mg (generic, ~R45/month) or atorvastatin 20mg (~R55/month) |
| Annual management cost | R1,900 (mild) to R74,600 (severe with PCSK9 inhibitor) |
| Main financial risk | Cardiovascular complications — cardiac event R200,000; stroke R250,000 in private hospital |
Understanding Hyperlipidaemia
Hyperlipidaemia means elevated fats (lipids) in your blood. The two main concerns are:
LDL cholesterol ("bad cholesterol"): the primary driver of plaque build-up in arteries (atherosclerosis). High LDL is the most important treatable cardiovascular risk factor.
Triglycerides: elevated levels, especially in combination with low HDL ("good cholesterol"), significantly increase cardiovascular risk, particularly in South African populations where triglyceride elevation is the most common pattern.
HDL cholesterol ("good cholesterol"): protective. Low HDL, even with normal LDL, is a risk factor.
Hyperlipidaemia is almost entirely asymptomatic. There are no symptoms until arteries are significantly blocked or a cardiovascular event occurs. This is why routine cholesterol screening is important.
South Africa's Context
A 2021 study found dyslipidaemia in 76.7% of South African adults with comorbidities. The DYSIS South Africa study found that even among statin-treated patients, 50.3% did not achieve their LDL-C target — suggesting significant undertreatment despite medication.
Familial Hypercholesterolaemia (FH): A genetic condition causing very high LDL from birth. FH is significantly underdiagnosed in SA. If a close family member (parent, sibling, child) had a cardiac event before the age of 55, ask your doctor about FH screening. FH changes both the clinical approach and your medical aid coverage considerations substantially.
Treatment in South Africa
First-Line: Statins
Statins are the most effective and most studied class of cholesterol-lowering drugs. They reduce LDL-C by 30–55% depending on the agent and dose. All major statins now have generic equivalents available in SA at low cost.
Medication Cost Table (2026 Estimates)
| Medication | Class | Estimated Monthly Cost | CDL Funded |
|---|---|---|---|
| Simvastatin 20mg (generic) | Low-moderate intensity statin | ~R45 | Yes |
| Atorvastatin 20mg (generic) | Moderate-high intensity statin | ~R55 | Yes |
| Rosuvastatin 10mg (generic) | High intensity statin | ~R80 | Yes |
| Ezetimibe 10mg (generic) | Cholesterol absorption inhibitor | ~R200 | Scheme-dependent |
| Evolocumab 140mg (Repatha) — PCSK9 inhibitor | Monoclonal antibody | ~R5,500 | NOT CDL standard |
All costs are 2026 SEP estimates pending SAHPRA verification.
Annual Cost Breakdown
| Severity | Medication | Visits & Tests | Estimated Annual Total |
|---|---|---|---|
| Mild (low-risk, generic statin) | R540 | R1,360 | ~R1,900 |
| Moderate (high-intensity statin + specialist) | R960 | R2,960 | ~R3,920 |
| Severe — statin + ezetimibe | R3,540 | R6,800 | ~R10,340 |
| Severe — statin + PCSK9 inhibitor | R67,800 | R6,800 | ~R74,600 |
The PCSK9 inhibitor scenario is rare but important: a patient on a PCSK9 inhibitor faces ~R74,000/year in medication costs, almost entirely out-of-pocket.
Your Medical Aid and High Cholesterol
What your scheme must fund (CDL 006)
All registered medical schemes must cover hyperlipidaemia at PMB level (CDL 006). This covers:
- GP consultations for lipid management
- Generic statin therapy (simvastatin, atorvastatin, rosuvastatin — all generics funded)
- Annual fasting lipid profile, liver function tests, fasting glucose
What the CDL does NOT automatically fund: - Ezetimibe (requires failure of statin first — scheme-dependent) - PCSK9 inhibitors (Repatha, Praluent) — exceptional needs only; most patients pay out-of-pocket - Advanced lipid tests (lipoprotein(a), ApoB) - Originator brand statins (you pay the difference over generic)
Familial Hypercholesterolaemia and Exceptional Needs
If you have a diagnosed FH, your LDL-C target is much lower (< 1.4–1.8 mmol/L) and generic statins alone are often insufficient. PCSK9 inhibitors dramatically lower LDL-C (50–60% additional reduction) but are not in the CDL formulary. Accessing scheme funding for PCSK9 inhibitors requires: 1. Documented FH diagnosis (genetic test or clinical criteria) 2. Failed adequate trials of maximum-dose statin + ezetimibe 3. Specialist (cardiologist or lipidologist) motivation 4. Scheme exceptional needs committee approval
This process can take weeks to months. Many FH patients self-fund or go without.
The Gap Cover Question
Cholesterol medication costs R45–80/month for a generic statin. This is almost the cheapest chronic medication in SA. Your scheme funds it fully. Gap cover has no role in your day-to-day hyperlipidaemia management.
The relevance of gap cover is identical to hypertension: high cholesterol is a cardiovascular risk factor. The financial exposure is not in the medication — it's in the cardiac or neurological event that years of uncontrolled high LDL eventually cause. Cardiologist and neurologist specialist shortfalls on major cardiovascular admissions can run R15,000–R80,000. Gap cover closes that exposure.
For patients on PCSK9 inhibitors, the OOP medication cost is the primary concern, not gap cover. No gap cover product addresses chronic medication costs — that's a scheme formulary problem, not a gap problem.
South African Sources
- Erasmus et al. (2022) — Prevalence, patterns and determinants of dyslipidaemia among SA adults with comorbidities. Scientific Reports
- DYSIS South Africa (2013) — Dyslipidaemia in statin-treated patients. PMC
- Council for Medical Schemes: CDL 006 PMB Algorithm
Check your high cholesterol cover on AURA →
Medical disclaimer: Educational purposes only. Consult a healthcare provider for your personal situation. All medication costs are 2026 estimates pending SAHPRA SEP verification.