Repatha® Medicare Coverage

Repatha®
Chemical name: Evolocumab

Typical dosage: 1 ml of 140mg/ml

Typical type: Injector1

Repatha® is a prescription medication used to treat high cholesterol and lower the chance of heart attack or stroke. It is an injectable drug currently available as a brand medication.

Repatha lowers bad cholesterol called LDL in adults with cardiovascular disease to reduce their risk of heart attack and stroke. Repatha can be used with other cholesterol-lowering agents for additional LDL lowering.

It is an injection that is given under the skin (subcutaneously) every 2 weeks or monthly. It comes in a single-dose prefilled autoinjector, but the dose that is right for you will be determined by your provider.

Common side effects with this medication include symptoms of cold or flu, back pain, higher blood sugar levels and redness or bruising at the injection site.

Does Medicare cover Repatha?

Yes! 74% of Medicare Advantage plans and Medicare Part D plans cover Repatha.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 Repatha.

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Average costs for Repatha 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.
$518 – $1,202 $95 – $1,201

Additional information

High cholesterol, specifically higher levels of LDL cholesterol, is bad because it builds up in the arteries. This decreases blood flow to the heart and body, increasing the risk of having a heart attack or stroke.

Repatha works differently than standard cholesterol medications called statins. Repatha acts by helping the liver clear LDL cholesterol from the blood through limiting the actions of PCSK9, a protein in the liver that inhibits the liver from doing this job.

Repatha taken together with a statin can dramatically lower LDL.

This medication should not be injected with other injectable medications at the same injection site. Serious allergic reactions have occurred to this medication.

 

 

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.

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

1 GoodRx. Repatha. Retrieved May 2019, from www.goodrx.com/repatha.

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.