OBJECTIVES:  Hyperlipidemia imposes substantial costs on the health care system. The standard of care is HMG-CoA reductase inhibitors (statins). Since 2006, many statins have gone generic, causing significant cost savings. The objective of this study was to quantify the past and future oral lipid modifying therapy (LMT) market size in the top 5 European markets (France, Germany, Italy, Spain and United Kingdom, EU5), taking into consideration events such as patent expirations, new LMTs, and government policies. METHODS:  A four-step approach was utilized to describe the historical and future budgetary impact of oral LMTs in the EU5. 1) Historical ex-manufacturer sales data from 2005–2015, (IMS MIDAS Quarterly Database from retail and hospital panels, and sales and medical audits) quantified segments within the oral LMT market, contextualized historic growth drivers and determined their implications for future market growth, 2) Baseline historic trend forecast of oral LMT market treatment days for 2016–2025 developed via exponential smoothing regression, 3) Determined impact of future events on the baseline historic trend forecast and 4) 10-year forecast of the oral LMT market, using ex-manufacturer prices, integrated both the baseline forecast and future events. RESULTS:  In 2005-2015, the EU5 oral LMT market volume grew at 4.2% 10-year compound annual growth rate (CAGR), reaching 20.3 billion treatment days in 2015. The UK led the EU5 with 2.8 billion treatment days, while France experienced the lowest growth (1.7% CAGR). Total EU5 revenue decreased (-3.8% CAGR). Over the next 10 years, oral LMT sales are projected to decrease (-6.5% CAGR). However, the volume of oral LMT utilization is expected to increase (0.8% CAGR) due to an aging population. CONCLUSIONS:  The increased availability of generic statins is projected to introduce significant cost savings for the treatment of hyperlipidemia via oral LMT despite projected increase in statin usage in the EU5.