BACKGROUND: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors demonstrate significant lipid-lowering effects, but the widespread use of anti-PCSK9 monoclonal antibodies remains limited. PURPOSE: This study is aimed at understanding patients' real-world experiences with anti-PCSK9 monoclonal antibodies from a subjective perspective and identifying key factors influencing medication adherence. METHODS: A qualitative research methodology was employed, involving face-to-face semistructured in-depth interviews with 24 individuals who had previously used anti-PCSK9 monoclonal antibodies. The interviews were guided by a thematic framework approach and recorded in their entirety. Posttranscription, Colaizzi's phenomenological analysis method was utilized to systematically collect and interpret patient-reported subjective experiences. RESULTS: Among those continuing treatment, the most common motivating factors were the anti-PCSK9 monoclonal antibodies' favorable efficacy and fewer adverse reactions. Among those discontinuing treatment, the primary reasons for stopping were high medication costs (62.5%), insufficient recognition of the necessity for continued use (62.5%), and unwillingness to use injection administration (68.75%). The underlying determinants of patients' behavioral patterns can be elucidated and mitigated by applying the health belief model and the theory of planned behavior. CONCLUSION: Research findings indicate that patients' willingness to use medication is primarily influenced by three factors: perceived good efficacy, health awareness, and fear of needles and economic burden. We are aimed at enhancing long-term clinical benefits for patients and improving treatment adherence, establishing education about drug efficacy and necessity, promoting innovation of nasal spray or long-acting implant formulations, and achieving precise medical insurance coverage for high-risk populations. TRIAL REGISTRATION: ChiCTR registration number: ChiCTR2500101339.