Repatha (Evolocumab) Compounded Equivalent: Why It Doesn't Exist and How to Get Repatha Affordably
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No compounded Repatha equivalent is established by FDA information
Key numbers
- 420 mgStarting monthly dose for homozygous familial hypercholesterolemia, per the labelSource: dailymed.nlm.nih.gov, as cited Nov 7, 2026
- 140 mgSize of each injection when a 420 mg dose is given as three shotsSource: dailymed.nlm.nih.gov, as cited Nov 7, 2026
- 30 minutesTime window in which the three injections of one 420 mg dose must be givenSource: dailymed.nlm.nih.gov, as cited Nov 7, 2026
From the public record
Medicaid prescriptions for evolocumab by state
State Medicaid programmes paid for 266,210 evolocumab prescriptions in 2025, with $168.3M reimbursed before rebates. California reported the most (70,985), followed by New York (41,580) and Kentucky (16,024); 52 states and territories reported any.
| Measure | Value | Note |
|---|---|---|
| Prescriptions paid by Medicaid, 2025 | 266,210 | |
| Total reimbursed before rebates, 2025 | $168.3M | |
| States and territories reporting | 52 | with at least one count CMS did not suppress |
| California | 70,985 prescriptions | $40.5M reimbursed |
| New York | 41,580 prescriptions | $33.4M reimbursed |
| Kentucky | 16,024 prescriptions | $10.0M reimbursed |
| Ohio | 11,915 prescriptions | $6.7M reimbursed |
| Pennsylvania | 10,425 prescriptions | $6.6M reimbursed |
How this was calculated
Matched each Medicaid product code to the FDA NDC Directory by labeler and product code, kept finished single-ingredient products, then summed prescriptions and reimbursement by state. National roll-up and suppressed rows dropped.
All single-ingredient evolocumab products in the FDA NDC Directory, fee-for-service and managed care, 2025
Counts under 11 are suppressed by CMS and left out, so totals are a floor. Amounts are before rebates. Differences between states reflect programme size and coverage rules. Compounded products are not included.
See the public record for Evolocumab
At a glance
- Drug / Repatha (evolocumab), a PCSK9 inhibitor monoclonal antibody [3]
- Form / 140 mg/mL prefilled pen, SureClick autoinjector or syringe, for subcutaneous use [3]
- Compounded equivalent / not established by FDA information; the FDA says biologics cannot be copied exactly [2]
- Copy route / FDA biosimilar category, which requires no clinically meaningful differences from the original [2]
- Approval / Amgen, BLA 125522, original approval 27 August 2015 [1]
- Dosing / 140 mg every 2 weeks or 420 mg once monthly [3]
What the FDA says about copying biologics
Evolocumab is a human monoclonal IgG2 antibody that binds PCSK9, the protein that normally binds the LDL receptor on liver cells and promotes its degradation; blocking that binding leaves more LDL receptors free to clear LDL from the blood [3]. It is a biologic. The FDA describes biologics as medicines that generally come from living organisms, including animal cells and microorganisms, with structures generally more complex than conventional chemical drugs and a more complicated manufacturing process [2]. The same FDA page states that biologics cannot be copied exactly [2].
That statement describes the difficulty of copying a biologic; it does not say whether anyone has made a compounded version of Repatha. The Drugs@FDA record lists Repatha as the product under BLA 125522 [1]. It confirms the approved product and does not address compounded versions.
What the FDA requires of a biosimilar
A biosimilar is a biologic that is highly similar to an already approved original biologic and has no clinically meaningful differences from it: same route of administration, same strength and dosage form, same potential side effects [2]. An interchangeable biosimilar may be substituted at the pharmacy without consulting the prescriber, subject to state pharmacy laws [2]. The FDA also notes that biosimilars may cost less than the original and may be covered by more insurance companies [2].
Repatha's original approval was on 27 August 2015 under BLA 125522 [1].
What a Repatha prescription involves
Repatha is prescription only, and patients or caregivers self-inject after training [3]. The label gives 140 mg every 2 weeks or 420 mg once monthly for adults at increased cardiovascular risk, adults with hypercholesterolemia, and adults and children 10 years and older with heterozygous familial hypercholesterolemia. For homozygous familial hypercholesterolemia it starts at 420 mg monthly [3]. The label says a 420 mg dose is given as three consecutive 140 mg injections within 30 minutes [3]. The label has no boxed warning, and its only Warning and Precaution is hypersensitivity, including angioedema [3].
The affordability question
The FDA's cost statements are general: biosimilars may cost less than the original biologic, may be covered by more insurance companies, and the FDA does not control drug prices [2]. Your pharmacy and your insurance plan are the places to get a real number for your own prescription [2].
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Frequently asked questions
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References
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- Drugs@FDA: FDA-Approved Drugs.
- Biosimilar and Interchangeable Biologics: More Treatment Choices | FDA.
- DailyMed - REPATHA- evolocumab injection, solution.
- Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA, et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 2017;376(18):1713-1722.
- Bohula EA, Marston NA, Bhatia AK, De Ferrari GM, Leiter LA, Nicolau JC, et al. Evolocumab in Patients without a Previous Myocardial Infarction or Stroke. N Engl J Med. 2026;394(2):117-127.