Paying for Repatha: Coverage and Cost Information

The US list price for Repatha (evolocumab) is $572.70 per month as of January 2025. Most patients pay substantially less. Understanding the actual cost landscape for PCSK9 inhibitor therapy is clinically relevant because prior authorization friction and cost concerns are the two primary barriers preventing eligible high-risk patients from accessing a medication with a 15% reduction in major cardiovascular events in the FOURIER trial.

Insurance coverage is broad. Repatha is covered for 98% of patients with commercial insurance, 93% with Medicaid, and 85% with Medicare. Out-of-pocket costs follow from there: approximately 88% of commercial prescriptions cost $50 or less; in Medicaid, 99% of prescriptions cost $10 or less; in Medicare, 73% cost $50 or less. For the roughly 12% of commercial patients and 27% of Medicare patients facing higher costs, access barriers are real.

Amgen’s co-pay card program can reduce commercial patient costs to $15 per month. Medicare Low-Income Subsidy beneficiaries may pay $12.15 or less. Prior authorization requirements have eased: approximately 30% of commercial plans no longer require prior authorization, and 80% of commercial and Medicare plans do not require additional documentation beyond the prescription.

These coverage statistics are manufacturer-reported and represent a snapshot. They reflect a landscape in which the majority of prescribed PCSK9 inhibitors are accessible at modest out-of-pocket cost to commercially and Medicaid-insured patients. The Medicare population, at 85% coverage and 73% with costs below $50, has meaningful but not universal access.

We rate the evidence moderate. This manufacturer-sourced coverage analysis for Repatha demonstrates that PCSK9 inhibitor access is broader than often assumed, though meaningful barriers persist in Medicare and among patients who are denied coverage under prior authorization requirements.