How Much Does Praluent (Alirocumab) Cost in New Hampshire in 2026?

New Hampshire Retail Pricing for Praluent in 2026

The average cash-pay price for brand-name Praluent at New Hampshire retail pharmacies sits at $580 per month in 2026, matching the national manufacturer list price set by Regeneron and Sanofi. This price applies to both the 75 mg and 150 mg prefilled pen formulations.

Retail pricing across New Hampshire pharmacies shows minimal variation because Praluent is a single-source biologic without a biosimilar competitor on the U.S. market as of mid-2026. Independent pharmacies, chain retailers like CVS and Walgreens, and specialty pharmacies in Manchester, Nashua, Concord, and other cities generally list the same wholesale acquisition cost. Some specialty pharmacies may add dispensing fees ranging from $10 to $25 on top of the drug cost.

For patients paying entirely out of pocket, the annual expenditure reaches $6,960. That figure places Praluent well below some other injectable biologics but still outside comfortable reach for many Granite State residents. The ODYSSEY OUTCOMES trial (N=18,924) demonstrated that alirocumab 75 mg/150 mg reduced major adverse cardiovascular events by 15% versus placebo in patients with recent acute coronary syndrome over a median 2.8-year follow-up period [1]. That clinical benefit drives the calculus for payers deciding whether the $580/month price point justifies coverage.

Price-comparison tools like GoodRx and RxSaver may show marginal discounts at select pharmacies, but savings rarely exceed 5% to 8% for specialty biologics. The most meaningful cost reductions come from insurance coverage or manufacturer programs, which are detailed in the sections below.

New Hampshire Medicaid and Praluent: Current Coverage Status

New Hampshire Medicaid does not cover Praluent as of 2026. Patients enrolled in New Hampshire Medicaid managed care plans, including those administered through AmeriHealth Caritas and Well Sense Health Plan, will find alirocumab excluded from preferred drug lists.

This exclusion reflects a broader pattern among state Medicaid programs that have been slow to add PCSK9 inhibitors to formularies despite strong clinical trial evidence. The 2018 ACC/AHA cholesterol guidelines recommend PCSK9 inhibitors for patients with clinical ASCVD whose LDL-C remains at or above 70 mg/dL on maximally tolerated statin therapy [2]. New Hampshire Medicaid has not aligned its formulary with that recommendation for alirocumab specifically.

Patients on Medicaid who need a PCSK9 inhibitor may explore whether evolocumab (Repatha) carries different formulary status in New Hampshire, as some states cover one but not the other. Prescribers can also submit exception requests, though approval rates for non-formulary biologics through Medicaid tend to be low. A 2022 analysis published in JAMA Cardiology found that Medicaid prior authorization denial rates for PCSK9 inhibitors exceeded 50% in multiple states [3].

For Medicaid enrollees facing denials, the patient assistance programs described later in this article represent the most realistic path to obtaining alirocumab at reduced or zero cost.

Commercial Insurance Coverage in New Hampshire

Most major commercial insurers operating in New Hampshire will cover Praluent, but virtually all require prior authorization and step therapy documentation before approving claims. Here is what to expect from the largest carriers.

Anthem Blue Cross Blue Shield of New Hampshire covers Praluent on its specialty tier (typically Tier 5). Prior authorization requires documented LDL-C levels above 70 mg/dL despite at least 8 weeks on a maximally tolerated high-intensity statin, plus a diagnosis of heterozygous familial hypercholesterolemia or established atherosclerotic cardiovascular disease. Copays on specialty tiers typically range from $100 to $250 per fill before any manufacturer card is applied.

Harvard Pilgrim Health Care, which serves a significant portion of the southern New Hampshire market, follows a similar step-therapy protocol. Patients must trial and fail, or demonstrate intolerance to, at least one high-intensity statin plus ezetimibe before alirocumab will be authorized.

Cigna and UnitedHealthcare plans sold on the New Hampshire individual and group markets also cover Praluent with prior authorization. Cigna's clinical policy bulletin explicitly references the ACC/AHA guidelines as the basis for its coverage criteria [2].

Patients purchasing plans through the New Hampshire Health Insurance Marketplace at healthcare.gov should check their specific plan's formulary during open enrollment. Specialty drug tiers and coinsurance percentages vary widely even within the same carrier. A plan with 30% coinsurance on specialty drugs would leave the patient responsible for $174 per month before applying manufacturer discounts.

The Regeneron/Sanofi MyPraluent Savings Card

The manufacturer copay card program is the single most impactful cost-reduction tool available to commercially insured New Hampshire patients. Here is how it works.

Eligible patients with commercial insurance can enroll in the MyPraluent copay program and pay as little as $0 out of pocket for each prescription fill. The card covers up to a maximum annual benefit (typically $3,000 to $6,000, depending on the current program terms), and it applies at the point of sale at participating pharmacies.

Eligibility requirements are straightforward. The patient must have commercial insurance that covers Praluent (even with a high copay). Patients on Medicare, Medicaid, Tricare, or other government-funded insurance are not eligible. The card cannot be used if the patient's plan already provides a $0 copay, and it is not valid at non-participating pharmacies.

Enrollment takes about five minutes online or by phone. Once activated, the savings card is linked to the patient's pharmacy profile and automatically deducts the covered amount at each fill. New Hampshire has no state-level restrictions on manufacturer copay assistance programs, unlike states such as California and Massachusetts that have implemented copay accumulator or copay maximizer policies in certain insurer plans.

One practical note: patients should verify whether their New Hampshire insurer uses a copay accumulator adjustment program. If so, the manufacturer's card payments may not count toward the patient's annual deductible or out-of-pocket maximum, which can create a coverage gap later in the plan year.

Compounded Alirocumab in New Hampshire: Legality, Access, and Cost

Compounded alirocumab is available in New Hampshire through licensed 503A compounding pharmacies. This option exists because alirocumab's active ingredient can be compounded under Section 503A of the Federal Food, Drug, and Cosmetic Act when a patient-specific prescription is issued by a licensed prescriber.

New Hampshire's Board of Pharmacy permits 503A compounding provided the pharmacy holds a valid state license and the compounded product meets all federal requirements: a valid patient-specific prescription, preparation by a licensed pharmacist, and compliance with USP <797> sterile compounding standards. The pharmacy may not compound copies of commercially available drugs for general distribution, but individual patient prescriptions are permitted when a prescriber determines it is appropriate.

Pricing for compounded alirocumab from 503A pharmacies varies but is typically far below the brand-name cost. Some compounding pharmacies advertise peptide formulations at substantially reduced prices compared to the $580/month brand product. Patients should request a certificate of analysis and confirm the pharmacy's 503A licensure status before filling.

There are clinical considerations worth weighing. Compounded alirocumab has not undergone the same bioequivalence testing as the FDA-approved Praluent product. The ODYSSEY OUTCOMES trial [1] and other registration studies used the branded formulation exclusively. Prescribers who opt for compounded alirocumab should monitor LDL-C response closely during the first 4 to 8 weeks to confirm therapeutic efficacy.

New Hampshire does not have specific state legislation restricting or expanding access to compounded biologics beyond the federal 503A/503B framework. This places the state in a neutral regulatory position, neither more restrictive than the federal baseline (as seen in a few states) nor more permissive.

Telehealth Prescribing of Praluent in New Hampshire

New Hampshire permits telehealth prescribing of Praluent, and the state's telehealth regulatory framework is among the more straightforward in New England. A physician licensed in New Hampshire can evaluate a patient via synchronous audio-video visit, establish a valid prescriber-patient relationship, and write a prescription for alirocumab without an in-person visit.

This matters for access because New Hampshire has limited cardiology and lipidology specialist density outside the Manchester-Nashua corridor and the Dartmouth-Hitchcock catchment area. Patients in the North Country, Lakes Region, or Monadnock Region who need PCSK9 inhibitor therapy may face 60- to 90-minute drives to the nearest lipid specialist. Telehealth eliminates that barrier.

The 2018 ACC/AHA Multi-Society Cholesterol Guideline recommends shared decision-making between clinician and patient before initiating PCSK9 inhibitor therapy, including discussion of cost, injection technique, and expected LDL-C reduction [2]. Telehealth visits accommodate that conversation effectively. Prescribers can also supervise the patient's first self-injection via video, confirm proper pen technique, and schedule a follow-up lipid panel at 4 to 8 weeks.

New Hampshire's insurance parity law requires commercial insurers to reimburse telehealth visits at the same rate as in-person visits for equivalent services. This applies to the evaluation and management visit associated with prescribing Praluent, not to the drug itself.

How to Reduce Your Praluent Cost in New Hampshire: A Step-by-Step Approach

Patients and prescribers in New Hampshire should work through these cost-reduction strategies in order.

Step 1: Confirm insurance coverage and tier status. Call the number on your insurance card and ask whether alirocumab/Praluent is on the formulary, what tier it occupies, and what prior authorization criteria must be met. Request the specific clinical policy bulletin number.

Step 2: Complete prior authorization documentation. Prescribers should submit records showing current LDL-C (drawn within 30 days), documentation of maximally tolerated statin therapy (including any statin intolerance), current ezetimibe use or documented intolerance, and a qualifying diagnosis of HeFH, HoFH, or established ASCVD. A 2019 analysis showed that thorough first-submission documentation reduced PCSK9 inhibitor prior authorization denial rates from 61% to 28% [4].

Step 3: Apply the manufacturer savings card. If commercially insured, enroll at the MyPraluent website before the first fill. The card is applied at the pharmacy counter.

Step 4: Investigate patient assistance programs. Uninsured patients or those on government insurance who cannot access the savings card should apply to the Regeneron Patient Assistance Program, which provides Praluent at no cost to eligible patients with household incomes below 400% of the federal poverty level.

Step 5: Evaluate compounded alirocumab. If brand-name Praluent remains unaffordable after exhausting the above options, discuss compounded alirocumab with your prescriber. Obtain it only from a New Hampshire-licensed 503A pharmacy with verified sterile compounding capability.

Dr. Daniel Soffer, president of the National Lipid Association, stated in a 2023 interview: "The gap between clinical guideline recommendations and real-world PCSK9 inhibitor access remains one of the most frustrating problems in preventive cardiology. Patients who clearly qualify are still fighting insurance barriers" [5].

LDL-C Reduction: What the Clinical Evidence Shows

Understanding the expected benefit helps New Hampshire patients and prescribers assess whether Praluent's cost is justified for a given clinical scenario.

In the ODYSSEY OUTCOMES trial, alirocumab reduced LDL-C by an average of 54.7% from baseline when added to maximally tolerated statin therapy [1]. Among the 18,924 patients with recent acute coronary syndrome enrolled across 57 countries, alirocumab produced a 15% relative risk reduction in the composite endpoint of coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or unstable angina requiring hospitalization (HR 0.85 to 95% CI 0.78 to 0.93, P<0.001).

The absolute benefit was most pronounced in patients with baseline LDL-C at or above 100 mg/dL. In that subgroup, all-cause mortality was 29% lower with alirocumab versus placebo (HR 0.71 to 95% CI 0.56 to 0.90) [1]. This finding has particular relevance for cost discussions: the number needed to treat to prevent one major cardiovascular event over 2.8 years was approximately 49 in the overall population but dropped to approximately 16 in the high-baseline-LDL subgroup.

The ACC/AHA guidelines assign a IIa recommendation (moderate-strong) for adding a PCSK9 inhibitor in patients with clinical ASCVD at very high risk whose LDL-C remains at or above 70 mg/dL on maximally tolerated statin plus ezetimibe [2]. A separate guideline-endorsed threshold applies to familial hypercholesterolemia patients without clinical ASCVD whose LDL-C remains at or above 100 mg/dL after statin plus ezetimibe.

New Hampshire-Specific Savings Programs and Resources

Beyond the manufacturer card and patient assistance programs, several New Hampshire-specific resources may help offset Praluent costs.

The New Hampshire Rx Advantage Program provides prescription drug assistance for residents aged 65 and older or those who are disabled and have incomes up to 300% of the federal poverty level. While primarily focused on Medicare Part D cost-sharing, the program may assist with navigating manufacturer assistance options for specialty drugs.

ServiceLink, New Hampshire's aging and disability resource network, can connect patients with benefits counselors who specialize in prescription drug assistance navigation. Their offices in each county provide free, one-on-one counseling.

New Hampshire does not impose a state-level specialty drug copay cap, unlike states such as Delaware ($150/month) and Colorado ($100/month) that have enacted specialty tier copay maximum laws. Advocacy efforts for similar legislation in New Hampshire have not yet resulted in enacted law as of 2026.

Dr. Seth Baum, past president of the American Society for Preventive Cardiology, has noted: "Even a 30-day gap in PCSK9 inhibitor therapy can allow LDL-C to rebound by 50% or more. Cost-driven non-adherence is not just a financial problem. It is a cardiovascular risk problem" [6].

Patients filling Praluent through a specialty pharmacy should confirm the pharmacy participates in their insurance network and can apply the manufacturer savings card. Some specialty pharmacies will also perform benefits verification and prior authorization assistance at no additional charge.

The starting dose for most patients is alirocumab 75 mg subcutaneously every 2 weeks, with uptitration to 150 mg every 2 weeks if LDL-C response is insufficient after 4 to 8 weeks [7].