Background: Lipid management is a key aspect of secondary atherosclerotic cardiovascular disease (ASCVD) prevention. However, real-world studies show that ~72–88% of patients with ASCVD fail to meet their low-density lipoprotein cholesterol (LDL-C) target. Nonstatin agents are available as add-on therapies that can be utilized when maximally tolerated statins are insufficient to achieve LDL-C goals. This retrospective study aimed to evaluate the current prescribing habits of nonstatins as add-on therapy to statins for secondary ASCVD prevention at a federally qualified health center (FQHC). Methods: Patients were included if they had a history of clinical ASCVD, ≥1 lipid panel obtained during the study period, and were prescribed any intensity statin. Results: Among 398 included participants, 11.1% were prescribed nonstatin therapy and 35.9% were meeting a LDL-C target of <70 mg/dL. There was a significant association between being prescribed ezetimibe based on the type of healthcare coverage (p = 0.04) and a higher number of ASCVD qualifying indications (p < 0.01). Conclusions: Overall, nonstatins were found to be underutilized for LDL-C management in this underserved population. Future initiatives should target ways to optimize nonstatin therapy to optimize secondary ASCVD prevention.