Help about Repatha

I’m 39 now. At 36, I decided to get a CAC score as an untargeted preventative health screen, and it returned 57 (92nd percentile if I was age 45 - no data for my age). This was a mystery, because my LDL-c was only borderline high (low 100s), I did not have diabetes or hypertension, and my Lp(a) was about 20. Moreover, in recent years I had been watching my weight and working out like a fiend. I established with a cardiologist who essentially shrugged, and we decided there was no downside to starting a statin; we initally settled at rosuvastatin 20 but I pushed an increase to 40 despite meeting normal goals.

Now three years after my CAC score, I decide to get a third-party lab panel, again as an untargeted health screen. Well, my Lp(a) is retested, and it returns 196. I take this to my cardiology team, and we get a third to tie-break: 177. Clearly this increase isn’t a statin effect, and it probably explains my original CAC of 57 - very high for my age at the time.

I’m still on the rosuvastatin 40. My LDL-c is 41, LDL-p is 827, ApoB is 57. The thing is, these numbers are in the setting of extreme lifestyle management (diet monitoring, exercise) that if anything I’ll need to relax in coming years to accommodate life and relationships better. Moreover, that CAC score for age 36 makes me think my Lp(a) score may be underselling the degree at which I’m developing ASCVD. I don’t think it’d be unreasonable to start Repatha, but my understanding is that my numbers may not win insurance coverage. My cardiologist, who I’ll see in person this month but who communicated via his APRN about repeat my Lp(a) that he doesn’t think I need to update my meds, may not immediately be on board. Thoughts or experiences?