Does Medicare Cover Repatha?
High cholesterol can lead to a number of health problems, including increasing the likelihood of stroke and developing heart or kidney disease. Repatha is one of several prescription drugs you can take to lower your risk of these complications and manage your cholesterol.
While 95% of Medicare drug plans cover Repatha, costs vary between plans. In this post, we’ll talk about how Medicare covers Repatha, what to expect for your out-of-pocket costs, and how to find a drug plan that meets your needs.
Key takeaways:
Most Medicare prescription drug plans cover Repatha, but it’s important to check your plan’s formulary to see if it covers the drug.
Your out-of-pocket costs for Repatha depend on your drug plan. Once you’ve met your deductible, copays start at $45.
If the cost is too high, ask your doctor if there are cheaper, generic alternatives to Repatha that can work for you. You can also switch to a prescription drug plan that provides better coverage.
What is Repatha?
Repatha is a brand name drug for evolocumab, an injection used to treat high cholesterol. It can also reduce your risk of heart attack and stroke if you have heart disease.
Who is Repatha typically prescribed for?
Doctors usually prescribe Repatha for people who have tried other methods of lowering cholesterol levels that haven’t worked. These methods may include adopting a heart-healthy diet or taking other cholesterol medications.
You may also be prescribed Repatha if you have a genetic history of high cholesterol, a history of heart attacks and stroke, and/or a resistance to statins (more common medications that lower cholesterol).
How does Repatha work?
Like statins, Repatha works by lowering LDL (low-density lipoprotein) levels in the blood. A high level of LDLs can cause plaque buildup in the arteries and lead to cardiovascular disease.
Does Medicare Part D cover Repatha?
The vast majority of Medicare drug plans (Part D) cover Repatha. Only 5% of Medicare prescription drug plans don’t cover this medication. That’s a low number, but it’s still worth checking your plan’s formulary (drug list) to see if your plan covers Repatha. In some states, for example, Wellcare Value Script does not cover Repatha. The drug can cost more than $600 for a standard supply if you have to pay for it without insurance.
Out-of-pocket costs for Repatha
Your specific out-of-pocket costs for Repatha depend on your drug plan and whether you’ve reached your deductible or not. People typically pay around $45 for Repatha once they’ve reached their Part D deductible. In 2024, your drug plan deductible can’t exceed $545, but deductibles vary by plan.
Checking your drug plan formulary for coverage
Prescription drugs aren’t cheap. Checking your plan’s drug formulary and summary of benefits is the best way to anticipate your drug costs. If your plan doesn’t cover a drug that you need, you can ask your doctor to prescribe an alternative that your plan does cover. You can also switch to a prescription drug plan that better suits your needs during the Medicare annual Open Enrollment Period.
Comparing plans and finding the right one for you can be tough! Find a drug plan that covers the medications you need with help from a Chapter Medicare Advisor. Contact us at 855-900-2427 or schedule a time to chat to get started.