{"id":634599,"date":"2025-12-10T12:06:22","date_gmt":"2025-12-10T17:06:22","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=634599"},"modified":"2026-01-28T13:39:36","modified_gmt":"2026-01-28T18:39:36","slug":"repatha-assistance-for-medicare-patients","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/repatha-assistance-for-medicare-patients\/","title":{"rendered":"Does Medicare cover Repatha?"},"content":{"rendered":"

Repatha<\/span><\/a> (evolocumab) is a prescription drug approved by the U.S. Food and Drug Administration (FDA) to help adults and children aged 10 and up lower \u201cbad\u201d cholesterol (low-density lipoprotein cholesterol, or LDL-C) levels in the blood. Healthcare providers typically prescribe the injectable medication, along with dietary changes, to help people reduce the risk of heart attack, stroke, and other cardiovascular events. <\/span><\/p>\n

For Medicare beneficiaries, the cost of Repatha varies depending on whether the beneficiary has drug coverage, the type of drug plan they have, and the tier on which the heart medication is listed in the plan\u2019s drug formulary. Costs also may vary depending on a beneficiary\u2019s income and assets.<\/span><\/p>\n

Does Medicare cover Repatha?<\/span><\/h2>\n

\u201cMedicare Part D generally does cover Repatha, but coverage specifics depend on the individual plan\u2019s formulary and tier placement,\u201d says Elizabeth Rubin Ribak, MD, a board-certified emergency medicine physician and clinical advisor at Embers Recovery in Phoenix, Arizona. \u201cMost Part D plans list Repatha as a specialty-tier drug, which often means higher copays or coinsurance compared to generic medications.\u201d Most Medicare Advantage (Part C) plans also cover a single-dose SureClick Repatha autoinjector as part of that plan\u2019s drug coverage portion.<\/span><\/p>\n

If you have Original Medicare (Part A and Part B), and your healthcare provider administers Repatha in their office or clinic, your Part B insurance may cover the medication costs. If the drug is administered during your hospital or skilled nursing facility stay, Part A may cover it. In these specific instances, the cost sharing will follow Part A or Part B cost sharing rules.<\/span><\/p>\n

If you\u2019re unsure if your Medicare Part D plan covers Repatha, you can check its <\/span>drug formulary<\/span><\/a> (a list of approved medications). On a drug formulary, medications are organized into <\/span>four cost tiers<\/span><\/a>, which health plans use to guide beneficiaries toward the most cost-effective options. Repatha often lands on tier 3, meaning it\u2019s a non-preferred, brand-name prescription drug with a higher copay.<\/span><\/p>\n

Dr. Ribak adds that in many instances, people must receive prior authorization before their Medicare plan covers Repatha. <\/span>Prior authorization (PA)<\/span><\/a>, also known as prior approval, pre-authorization, or pre-certification, is a standard health insurance process in which your healthcare provider has to document that a specific medical service, equipment, or medication\u2014such as Repatha\u2014is medically necessary on behalf of the patient. Prescription drugs that often require a PA have a high price tag, potential for misuse, or generic alternatives available.\u00a0<\/span><\/p>\n

Your Medicare insurance plan may also require step therapy before covering the cost of Repatha. <\/span>Step therapy<\/span><\/a>, also known as fail-first or step protocol, is another restriction in which your health insurance company may ask you to try cheaper medications (such as generics) before moving up to more expensive ones like Repatha.<\/span><\/p>\n

How much does Repatha cost with Medicare?<\/span><\/h2>\n

The average list price for Repatha is <\/span>about $793<\/span><\/a> for 2, 1 mL of 140 mg\/mL syringes. According to Repatha\u2019s manufacturer, Amgen, about 74% of Medicare beneficiaries <\/span>pay $50 or less a month<\/span><\/a> for the injectable medication. How much your copay will be for Repatha will depend heavily on your Medicare drug plan and whether you\u2019ve reached your annual deductible. In 2026, no Part D prescription drug plans may have a deductible more than $615. In addition, the annual out-of-pocket maximum for Part D plans is $2,100. If you meet this amount in out-of-pocket expenses (not including premiums), you won\u2019t pay anything further for Repatha or other covered prescription medications for the rest of the calendar year.\u00a0<\/span><\/p>\n\t\t

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Save up to 80% on Repatha with SingleCare<\/p>\n\t\t\t

Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.<\/p>\n\t\t\t

\n\t\t\t\t
\n\t\t\t\t\tRepatha 1ml of 140 mg\/mL (2 Injection)\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t23666 - Hampton, VA\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t
\n\t\t\t\"Kroger\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$504.51\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
\n\t\t\t
\n\t\t\t\"Harris\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$504.51\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\tSee Repatha prices at all pharmacies<\/a>\n\t\t<\/div>\n\n\t\t\n

Repatha assistance for Medicare patients<\/span><\/h2>\n

If your Medicare drug plan has high copays for Repatha or doesn\u2019t cover the heart medication at all, there are other options you can explore to save money on your prescription.<\/span><\/p>\n

Here are some strategies for getting financial assistance for Repatha as a Medicare recipient:<\/span><\/p>\n

SingleCare discount card<\/span><\/h3>\n

A pharmacy savings card can help you lower the cost of your Repatha prescription. The <\/span>SingleCare discount card<\/span><\/a> is a free coupon that can help you save up to 80% on your prescriptions. With this savings card, you can pay $462 for 2, 1 mL of 140 mg\/mL syringes at Kroger\u2019s Pharmacy if Medicare doesn\u2019t cover your Repatha prescription. This price is significantly lower than the list price of the heart medication ($793), saving you more than $300 in out-of-pocket costs.\u00a0<\/span><\/p>\n

If your Medicare drug plan covers Repatha but your copay is too high, using a SingleCare prescription discount card can often give you a lower copay than your insurance plan.<\/span><\/p>\n

To get your discount, visit <\/span>Repatha\u2019s drug coupon page<\/span><\/a>, choose your preferred pharmacy with the best deal (the card works at most major pharmacies), and print or download it to your phone or tablet. You\u2019ll show the coupon card to your pharmacist to get your Repatha discount.<\/span><\/p>\n

You should be aware that you cannot combine use of a discount card with your Medicare drug coverage. Also, any money spent out of pocket when using a discount card at your pharmacy will not count toward your Medicare Part D deductible or annual out-of-pocket maximum.\u00a0<\/span><\/p>\n

Medicare Extra Help<\/span><\/h3>\n

Many Medicare Part D recipients meet the eligibility requirements for Medicare\u2019s <\/span>Extra Help program<\/span><\/a>. This federally-administered benefit for people with limited income and resources helps pay for copays, coinsurance, premiums, and deductibles.<\/span><\/p>\n

Many people automatically receive Extra Help if:<\/span><\/p>\n