Praluent® Medicare Coverage

Praluent®
Chemical name: Alirocumab

Typical dosage: 75mg/ml

Typical type: Injection1

Praluent® is a medication typically used to treat high cholesterol. Praluent is a brand name only medication and is available as a subcutaneous injection.

Praluent is a prescription medication that contains the active ingredient Alirocumab. Praluent is injected subcutaneously into the fatty part of the skin once every two to three weeks.

Praluent is a PCSK9 inhibitor that increases the body’s ability to clear bad cholesterol from the blood.

The major side effects of Praluent include nose and throat irritation, redness, swelling, itching and pain at the injection site and flu-like symptoms.

Does Medicare cover Praluent?

Yes! 85% of Medicare Advantage plans and Medicare Part D plans cover Praluent.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Praluent.

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

Average costs for Praluent with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$287 – $1,227 $265 – $1,227

Additional information

Praluent is used in combination with diet and a maximally tolerated statin medication for the treatment of high cholesterol.

Praluent is tolerated well by many patients who take it. However, it can cause extreme allergic reaction in some patients.

If you are taking Praluent, monitor for signs of allergic reaction such as rash; itching, red, swollen or peeling skin with or without fever; tightness in the chest or throat; trouble breathing or swelling of the mouth, face, lips, tongue or throat.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Praluent. Retrieved May 2019, from www.goodrx.com/praluent.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.