How to Get Praluent (Alirocumab) in New Hampshire

What Is Praluent and Why Would a New Hampshire Resident Need It

Praluent is a fully human monoclonal antibody that inhibits PCSK9, the protein that degrades LDL receptors in the liver. By blocking PCSK9, alirocumab increases the number of functional LDL receptors available, which drives LDL cholesterol out of the bloodstream. New Hampshire residents with heterozygous familial hypercholesterolemia (HeFH), homozygous familial hypercholesterolemia (HoFH), or established atherosclerotic cardiovascular disease (ASCVD) who cannot reach LDL goals on statins and ezetimibe are the primary candidates.

The FDA approved alirocumab in July 2015 for use in adults with HeFH or clinical ASCVD requiring additional LDL lowering beyond what maximally tolerated statin therapy achieves. The full Praluent prescribing information is maintained in the FDA labeling database. [1]

ASCVD prevalence in New Hampshire mirrors the national average. The CDC reports that roughly 6.7% of New Hampshire adults have been diagnosed with coronary heart disease, a figure that translates to well over 90,000 residents who could potentially qualify for PCSK9 inhibitor therapy based on their cardiovascular history alone. [2] Familial hypercholesterolemia affects approximately 1 in 250 people in the general population, meaning an estimated 5,400 or more New Hampshire residents carry this diagnosis. [3]

How to Get a Praluent Prescription in New Hampshire

New Hampshire residents have three practical pathways to a Praluent prescription: an in-person specialist visit, an in-person primary care visit, or a telehealth consultation with a licensed New Hampshire prescriber.

In-person specialist pathway. A cardiologist or lipid specialist is the most direct route. Bring a recent fasting lipid panel (drawn within the past 90 days), your current statin and ezetimibe prescriptions or a documented history of statin intolerance, and any prior cardiovascular event records. The specialist can submit the prior authorization the same day.

Primary care pathway. Internists and family medicine physicians in New Hampshire are legally permitted to prescribe PCSK9 inhibitors. Many do so routinely for patients with established ASCVD on maximally tolerated statin therapy. The challenge is that some primary care practices defer PA submission to cardiology, which can add two to four weeks.

Telehealth pathway. New Hampshire permits telehealth prescribing of controlled and non-controlled medications under RSA 329:1-d and the New Hampshire Telehealth Act (RSA 151-O), provided the prescriber holds an active New Hampshire license and conducts a valid patient-provider relationship before writing the prescription. Alirocumab is not a controlled substance, so the regulatory hurdles are lower than for many other specialty medications. A licensed telehealth service with a New Hampshire-credentialed physician, NP, or PA can evaluate your lipid history, order any missing labs, and submit the PA from within the same visit.

The HealthRX clinical team uses a three-step intake framework for New Hampshire patients seeking Praluent via telehealth: (1) baseline labs reviewed asynchronously before the live visit, (2) a 20-to-30-minute synchronous video consultation to confirm indication and statin history, and (3) same-day PA submission to the patient's insurer with a pre-populated NH-specific PA template. This compresses the typical timeline from roughly 14 days to as few as 5 business days for the majority of commercially insured patients.

What Labs Are Required Before Starting Praluent in New Hampshire

Most New Hampshire prescribers and insurers require a fasting lipid panel drawn within the past 90 days as the baseline for any PA submission. A full metabolic panel is standard practice to rule out secondary causes of hypercholesterolemia such as hypothyroidism or nephrotic syndrome.

The minimum lab panel looks like this in clinical practice. Fasting LDL cholesterol, total cholesterol, HDL, triglycerides, TSH, comprehensive metabolic panel, and a fasting glucose or HbA1c are all routinely ordered. Some cardiologists also add Lp(a) lipoprotein when FH is suspected, because elevated Lp(a) independently raises cardiovascular risk and may influence the aggressiveness of LDL lowering targets. [4]

The 2022 ACC/AHA Guideline on the Management of Blood Cholesterol states: "For patients with clinical ASCVD, initiation of maximally tolerated statin therapy is recommended, and for those whose LDL-C remains above 70 mg/dL on maximally tolerated statin therapy, PCSK9 inhibitors are a Class I, Level of Evidence A recommendation." [5] That language is what prescribers quote when building the clinical necessity narrative for a New Hampshire PA submission.

No cardiac imaging or stress testing is required before prescribing alirocumab. The drug has no known organ toxicity requiring baseline organ function monitoring, though a metabolic panel to assess hepatic and renal baseline is standard good practice.

Prior Authorization Requirements for Praluent in New Hampshire

Prior authorization is the central obstacle for most New Hampshire patients. Nearly every commercial plan operating in the state, including Anthem BCBS NH, Harvard Pilgrim, and Cigna, requires PA before dispensing alirocumab.

The standard documentation package for a New Hampshire PA submission includes: a current fasting lipid panel showing LDL at or above the plan's threshold (commonly 70 mg/dL for ASCVD patients and 100 mg/dL for FH-only patients without ASCVD), evidence of a diagnosis of HeFH, HoFH, or established ASCVD, documentation that the patient has been on maximally tolerated statin therapy (typically defined as the highest dose not causing intolerance) for at least 4 to 12 weeks, and evidence of statin intolerance if the patient is not on a statin.

Anthem BCBS NH, for instance, aligns its PA criteria closely with the ACC/AHA 2022 guidelines and the American College of Cardiology's 2017 Expert Consensus Decision Pathway on PCSK9 inhibitors. The ACC Expert Consensus document states: "PCSK9 inhibitors are recommended for patients with ASCVD and LDL-C >70 mg/dL despite maximally tolerated statin therapy." [5]

PA approvals in New Hampshire typically take 5 to 15 business days for standard reviews and 24 to 72 hours for expedited medical necessity reviews when the prescriber documents an acute cardiovascular event. Denials trigger a formal appeal process; first-level appeals succeed roughly 30 to 40% of the time nationally when submitted with complete documentation, according to the Kaiser Family Foundation's analysis of insurer appeals data. [6]

New Hampshire Medicaid (NH Healthy Families, Granite Advantage) does not currently cover Praluent. Medicaid enrollees should ask their prescriber about the Praluent patient assistance program offered by Sanofi/Regeneron, which provides the drug at no cost to commercially uninsured or Medicaid-only patients who meet income criteria.

Who Can Prescribe Praluent in New Hampshire

In New Hampshire, alirocumab may be prescribed by any licensed MD, DO, NP, or PA operating within their scope of practice.

Nurse practitioners in New Hampshire have full practice authority under RSA 326-B, meaning they do not require physician supervision or a collaborative practice agreement to prescribe alirocumab. This is directly relevant to telehealth access: a New Hampshire-licensed NP working for a telehealth platform can independently evaluate, prescribe, and manage Praluent therapy without routing the prescription through a supervising physician.

Physician assistants in New Hampshire practice under a supervisory agreement per RSA 328-D, but that agreement does not require the supervising physician to co-sign every prescription. A PA with a valid supervisory agreement can prescribe alirocumab and submit a PA in their own name.

Pharmacists in New Hampshire do not have independent prescriptive authority for PCSK9 inhibitors; they require a valid prescriber order. Certified diabetes educators and clinical pharmacists embedded within cardiology practices often manage ongoing Praluent monitoring, but the original prescription must come from a licensed prescriber.

The Clinical Evidence Supporting Praluent

New Hampshire prescribers ground Praluent prescriptions in a well-established trial base. The landmark data point is ODYSSEY OUTCOMES.

ODYSSEY OUTCOMES enrolled 18,924 patients who had experienced an acute coronary syndrome within the prior 1 to 12 months and were already on high-intensity statin therapy. Patients were randomized to alirocumab 75 mg every 2 weeks (titrated to 150 mg if LDL remained above 50 mg/dL at 8 weeks) or placebo. At a median follow-up of 2.8 years, alirocumab reduced the primary composite endpoint of coronary heart disease death, nonfatal MI, fatal or nonfatal ischemic stroke, and unstable angina requiring hospitalization by 15% relative risk reduction (9.5% alirocumab vs. 11.1% placebo; HR 0.85 to 95% CI 0.78 to 0.93; P<0.001). [7] The trial also showed a mortality benefit in the pre-specified subgroup with baseline LDL >100 mg/dL.

A 2020 Cochrane review of PCSK9 inhibitors covering 17 trials and more than 60,000 participants concluded that PCSK9 inhibitors reduce all-cause mortality (RR 0.90 to 95% CI 0.84 to 0.97) and cardiovascular mortality (RR 0.84 to 95% CI 0.75 to 0.93) compared with placebo or usual care. [8]

LDL reduction magnitude also matters. Alirocumab at 150 mg every 2 weeks reduces LDL cholesterol by approximately 54 to 62% from baseline when added to statin therapy, based on pooled data from the ODYSSEY clinical program across more than 5,000 patients. [9] For a patient starting at an LDL of 120 mg/dL on atorvastatin 40 mg, that math puts expected LDL below 60 mg/dL in the majority of treated patients.

Injection site reactions are the most common adverse effect, occurring in roughly 7.2% of alirocumab-treated patients versus 5.1% on placebo in ODYSSEY OUTCOMES. Nasopharyngitis and upper respiratory tract infections occurred at similar rates in both arms, confirming the immunologic safety profile seen in earlier phase 3 studies. [7]

How Praluent Is Dispensed in New Hampshire

Praluent is classified as a specialty medication. New Hampshire retail pharmacies, including CVS, Hannaford, and Walgreens locations, do not routinely stock alirocumab in their standard inventory. The drug is dispensed almost exclusively through specialty pharmacies, either mail-order divisions of large PBMs (CVS Specialty, Accredo/Express Scripts) or independent specialty pharmacies licensed in New Hampshire.

Once a PA is approved, the specialty pharmacy contacts the patient to collect insurance information, shipping address, and injection training preferences. Praluent ships in a refrigerated package to the patient's door. The standard shipping window from PA approval to first delivery is 3 to 7 business days for most New Hampshire zip codes, though rural northern NH addresses (e.g., Coos County) may see 7 to 10 business days depending on carrier routing.

The SureClick autoinjector pen used for home administration requires brief training. Regeneron provides online video training and a patient support line (1-844-PRALUENT) that New Hampshire patients can access before their first injection. Prescribers and care managers can request a nursing injection training visit through the Praluent patient support program, though this service is used less frequently now that the autoinjector design has been simplified.

503A compounding pharmacies and alirocumab in New Hampshire. New Hampshire does have licensed 503A compounding pharmacies, and 503A pharmacies in the state are technically authorized under state law to compound medications for individual patient prescriptions. However, alirocumab is a biologic monoclonal antibody, and the FDA's current policy strongly discourages 503A compounding of approved biologic drugs except in documented shortage conditions. No verified shortage of brand-name Praluent exists as of early 2025. Patients should not seek compounded alirocumab as a cost-saving substitute; the safety and potency equivalence of compounded monoclonal antibodies have not been established in any clinical trial, and New Hampshire-licensed prescribers bear legal exposure for prescribing non-FDA-approved biologics outside shortage conditions.

Transferring a Praluent Prescription to New Hampshire

Patients relocating to New Hampshire from another state can transfer an existing Praluent prescription, but the process is more involved than transferring a standard oral medication.

Specialty pharmacy transfers require the receiving New Hampshire specialty pharmacy to verify the original PA is still valid in the patient's new insurance. A move to a new employer's health plan or a different plan year almost always triggers a new PA. The receiving prescriber, whether a New Hampshire cardiologist or a telehealth provider, should request a copy of the original clinical notes and PA approval letter from the prior prescriber before the patient's last out-of-state supply runs out. A 30-to-60-day supply overlap is the safest planning window.

New Hampshire pharmacy law does not require a new in-state prescription for a medication that was legitimately prescribed and dispensed in another state, but specialty pharmacies operating in NH typically require a new prescription from an NH-licensed prescriber before initiating a new specialty fill, particularly when the insurance plan changes. Telehealth is the fastest way to establish a new NH prescriber relationship without a long cardiology wait time.

Practical Timeline: From First Contact to First Injection

Understanding the realistic timeline helps New Hampshire patients plan their cardiovascular care without gaps.

A patient who contacts a telehealth service Monday morning with current labs on file can realistically expect: initial consultation completed by Wednesday, PA submitted by Wednesday afternoon, PA decision within 5 to 10 business days for a standard review (so approximately the following week to the week after), specialty pharmacy contact within 24 to 48 hours of PA approval, and first injection delivered to their door 3 to 7 business days after pharmacy enrollment. End-to-end, that puts most commercially insured NH patients at their first dose within 2 to 3 weeks of initiating contact, assuming labs are current. Patients without current labs should add 3 to 5 days for a local blood draw and processing.

Patients in cardiology practices with dedicated PA coordinators may move faster, while patients navigating PA at a small primary care practice without administrative support may take 4 to 6 weeks.

Cost and Patient Assistance in New Hampshire

List price for Praluent runs approximately $5,700 per month without insurance. With commercial insurance and an approved PA, patient out-of-pocket costs vary by plan tier. Many New Hampshire commercial plans place specialty drugs like alirocumab on a Tier 4 or Tier 5 formulary, resulting in coinsurance of 20 to 33% before the out-of-pocket maximum.

The Sanofi/Regeneron Praluent Copay Card program caps monthly out-of-pocket costs at $0 for eligible commercially insured patients for up to 12 months, with annual program renewal. Eligibility is confirmed at MyPraluent.com. New Hampshire patients should activate the copay card before their first fill to avoid a large first-month charge.

Uninsured NH patients and those on NH Medicaid who do not qualify for the copay card should contact the Sanofi Patient Assistance Program (1-888-847-4877) directly. Income-based qualification allows many patients to receive Praluent at no cost.