How to Get Repatha (Evolocumab) in New Hampshire

What Repatha Is and Why LDL-C Reduction Matters

Evolocumab (Repatha) is a fully human monoclonal antibody that blocks PCSK9, the protein responsible for degrading LDL receptors on hepatocytes. Fewer PCSK9 molecules means more LDL receptors remain on the liver surface, pulling LDL-C out of the bloodstream with each pass. The result is a degree of LDL-C reduction that statins alone cannot match for high-risk patients.

The FDA approved evolocumab in August 2015 for adults with primary hyperlipidemia, HeFH, HoFH, and established atherosclerotic cardiovascular disease (ASCVD) requiring additional LDL-C lowering beyond statins and diet [1]. The approval was supported by a broad clinical program, the most cited piece of which is the FOURIER outcomes trial.

In FOURIER (N=27,564 patients with established ASCVD on maximally tolerated statin therapy), evolocumab 140 mg every 2 weeks or 420 mg monthly reduced LDL-C by 59% relative to placebo (from a median 92 mg/dL to 30 mg/dL) at 48 weeks, and cut the primary composite endpoint of CV death, MI, stroke, unstable angina, or coronary revascularization by 15% (HR 0.85 to 95% CI 0.79-0.92, P<0.001) over a median 2.2 years [2]. That trial enrolled patients with baseline LDL-C as low as 70 mg/dL, confirming benefit even at levels once considered acceptable.

The 2022 ACC/AHA Guideline on the Management of Blood Cholesterol states: "For patients with clinical ASCVD in whom maximally tolerated statin therapy and ezetimibe have not achieved an LDL-C goal of <70 mg/dL, adding a PCSK9 inhibitor is reasonable (Class IIa, Level B-R)" [3]. New Hampshire prescribers apply this same national standard to local patients.

Beyond ASCVD, patients with HeFH often cannot reach guideline-recommended LDL-C targets on statins alone. The RUTHERFORD-2 trial (N=329 HeFH patients) demonstrated a 59.2% placebo-corrected LDL-C reduction with evolocumab at 12 weeks (P<0.001) [4]. For HoFH, the TESLA Part B trial (N=49) showed a 30.9% reduction, meaningful even in patients with severely impaired receptor function [5].

New Hampshire Telehealth Rules and Repatha Prescribing

New Hampshire permits telehealth prescribing of controlled and non-controlled medications under RSA 329:1-a and the New Hampshire Board of Medicine's telehealth policy, provided the prescriber holds a valid NH license or a qualifying multistate compact license [6]. Evolocumab is not a controlled substance, so the prescribing pathway is comparatively straightforward.

A telehealth visit qualifies when the provider establishes a valid patient-provider relationship, reviews relevant medical history and recent lab work, and documents clinical decision-making in the medical record. Audio-video visits meet the standard; audio-only visits require additional documentation justifying why video was not available [6].

For New Hampshire residents, the practical consequence is direct. You can consult a cardiologist or lipidologist via a telemedicine platform, share a recent lipid panel, and receive a Repatha prescription without driving to a specialist office. The prescription routes to a specialty pharmacy, which ships to your New Hampshire address, typically within 5-10 business days from approval.

The American Heart Association's 2023 statement on telehealth for cardiovascular care concluded that remote prescribing of lipid-lowering agents improves adherence and reduces time-to-treatment in underserved areas, supporting telehealth as a clinically appropriate pathway for PCSK9 inhibitor access [7].

Labs and Clinical Documentation Required Before Prescribing

Most prescribers and all commercial prior authorization forms require specific documentation before approving Repatha. Getting labs drawn before your first visit shortens the overall timeline considerably.

Minimum lab work:

• Fasting lipid panel (total cholesterol, LDL-C, HDL-C, triglycerides), drawn within the past 90 days
• LDL-C on maximally tolerated statin therapy, or documentation of statin intolerance with a recorded reason (myalgia with elevated CK, hepatotoxicity, or documented patient refusal after counseling)
• Baseline liver function tests (ALT, AST)
• Fasting glucose or HbA1c if metabolic syndrome is suspected (relevant for cardiovascular risk stratification)

The 2018 ACC/AHA Multisociety Guideline on Blood Cholesterol specifies that a fasting LDL-C >70 mg/dL despite maximally tolerated statin plus ezetimibe in a very high-risk ASCVD patient justifies PCSK9 inhibitor initiation [3]. Documenting that exact threshold in the chart is the single most important step for prior authorization approval.

Thyroid function (TSH) is worth ordering at baseline because hypothyroidism causes secondary hypercholesterolemia and must be treated before labeling a patient statin-refractory [8]. A 2019 Endocrine Society Clinical Practice Guideline confirms that untreated hypothyroidism can raise LDL-C by 8-30 mg/dL, masking the true statin response [8].

HealthRX Prior Authorization Evidence Checklist (NH commercial insurers):

1. Current LDL-C value on maximally tolerated statin (within 90 days)
2. Statin trial documentation: name, dose, duration, and reason for discontinuation or dose ceiling
3. Ezetimibe trial: 10 mg daily for at least 90 days, with resulting LDL-C value
4. Diagnosis code: I78.01 (HeFH), I78.02 (HoFH), or I25.10 (ASCVD)
5. Clinical notes supporting very high risk: two or more major ASCVD events, or one major event plus high-risk conditions per the 2018 ACC/AHA guideline [3]
6. Prescriber attestation that diet optimization has been attempted

Insurers that do not receive all six elements in the first submission return a technical denial, which resets the clock by 5-7 business days. Submitting a complete package the first time is the fastest path to approval.

Who Can Prescribe Repatha in New Hampshire

New Hampshire law permits any licensed prescriber with full prescriptive authority to write for evolocumab. That includes MDs, DOs, nurse practitioners (APRNs with full practice authority under RSA 326-B:11), and physician assistants (PAs) with NH prescriptive authority [9].

APRNs in New Hampshire operate under full practice authority without a mandated physician collaboration agreement for prescribing non-controlled medications [9]. This is clinically significant because it means telehealth platforms staffed by NPs or PAs can independently initiate a Repatha prescription in NH, provided the provider holds a current NH license or compact license.

Cardiologists and lipidologists carry the deepest familiarity with PCSK9 inhibitor protocols, and some commercial insurers apply less scrutiny to PA submissions from cardiology practices versus primary care. When LDL-C targets are complex or the patient has HoFH (a rarer condition requiring LDL-C reductions beyond what standard statin protocols achieve), a specialist prescription reduces PA friction.

The ACC 2022 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction recommends that the prescribing clinician document cardiovascular risk category explicitly, as insurers increasingly use ACC/AHA risk tier language in their PA criteria [10].

Prior Authorization in New Hampshire: What to Expect

Prior authorization for Repatha is required by virtually every commercial insurer operating in New Hampshire, including Anthem BCBS NH, Harvard Pilgrim, Cigna, and Aetna. NH Medicaid does not cover Repatha as of 2025, which means state insurance enrollees must pursue manufacturer assistance programs instead.

The standard commercial PA process runs 3-7 business days for a standard review and 24-72 hours for an expedited review when a cardiologist documents urgent clinical need. Appeals, if required, extend the timeline by 10-14 business days under NH insurance law.

Anthem BCBS NH criteria (representative of the NH commercial market) require: LDL-C >70 mg/dL despite maximally tolerated statin plus ezetimibe for at least 90 days; a confirmed diagnosis of ASCVD, HeFH, or HoFH; and prescriber attestation of cardiovascular risk tier [11]. A 2021 analysis in JAMA Cardiology found that 52% of first-time PCSK9 inhibitor PA submissions were initially denied, with documentation gaps (missing statin trial data or LDL-C values) driving 74% of those denials [12]. Submitting a complete file, using the framework above, is the strongest way to avoid that pattern.

Step therapy requirements are common. Most NH commercial plans require a documented trial of ezetimibe 10 mg for at least 90 days before approving a PCSK9 inhibitor, unless the patient has HoFH or documented ezetimibe intolerance [11].

Pharmacies Dispensing Repatha in New Hampshire

Repatha is a specialty biologic dispensed through specialty pharmacies rather than standard retail chains. The primary specialty pharmacy networks that service New Hampshire addresses include:

• Accredo (Express Scripts specialty network)
• CVS Specialty
• Walgreens Specialty Pharmacy
• Optum Specialty Pharmacy

Each ships temperature-controlled packages via overnight courier to NH residential addresses. The auto-injector pens and prefilled syringes require refrigeration (2-8 degrees Celsius) and should not be left in a mailbox during summer months [1].

New Hampshire has licensed 503A compounding pharmacies under RSA 318-C. Under federal law (21 U.S.C. 353a), 503A pharmacies may compound drug preparations for individual patients upon receipt of a valid prescription [13]. Compounded versions of evolocumab exist but are not interchangeable with FDA-approved Repatha, and the FDA has not approved any compounded PCSK9 inhibitor product. The clinical and regulatory risks of compounded biologics are not equivalent to the approved product, and the HealthRX medical team does not recommend compounded evolocumab as a substitute for branded Repatha.

Patients who receive Repatha via specialty pharmacy should confirm cold-chain delivery before accepting a package. The FDA drug label specifies that Repatha stored above 25 degrees Celsius for more than 30 days should be discarded [1].

Cost, Copay Cards, and Patient Assistance in New Hampshire

The list price for Repatha is approximately $7,400 per month without insurance. Commercial insurance with PA approval typically reduces the patient cost to $25-$200 per month in copays or coinsurance, depending on plan design.

Amgen SUPPORTS Patient Assistance Program: Uninsured or underinsured patients who meet income criteria (up to 600% of the federal poverty level) may qualify for free Repatha through Amgen's patient assistance program. Applications are submitted directly through Amgen's website or by calling 1-844-REPATHA [14].

Amgen Repatha Copay Card: Commercially insured patients with Part D or commercial coverage may reduce their monthly out-of-pocket cost to as low as $0 using the Amgen copay card. Medicare Part D patients are not eligible for manufacturer copay cards under federal anti-kickback statutes, but the Amgen SUPPORTS program does provide separate Medicare assistance [14].

A 2023 study in the Journal of Managed Care and Specialty Pharmacy (N=4,218 patients) found that copay card enrollment increased PCSK9 inhibitor adherence at 12 months by 34% compared to patients without cost assistance, with adherence defined as a medication possession ratio >0.80 [15]. Connecting patients to cost assistance at the time of prescription is therefore both a financial and a clinical intervention.

For NH Medicaid enrollees, evolocumab is not on the NH Medicaid preferred drug list as of 2025. The clinical team at HealthRX recommends these patients pursue the Amgen SUPPORTS program and document their Medicaid status during the application.

Transferring an Existing Repatha Prescription to New Hampshire

Patients relocating to New Hampshire who have an active Repatha prescription from another state can transfer that prescription to a specialty pharmacy licensed in NH, provided the prescribing physician is either licensed in NH or holds a multistate compact license recognized in NH. If the original prescriber does not hold NH licensure, the patient needs a new prescription from an NH-licensed provider.

The simplest transfer path for relocating patients: contact the specialty pharmacy handling your current prescription, provide your new NH address, and ask the pharmacy to verify whether your prescriber holds NH licensing. If not, a telehealth visit with an NH-licensed provider can establish continuity of care and issue a fresh prescription the same day.

New Hampshire does not have a state prescription drug monitoring program (PDMP) requirement for non-controlled substances like evolocumab, so no PDMP query is required during the prescribing encounter [9]. The transfer process is cleaner for non-controlled specialty drugs than for opioids or stimulants.

Monitoring After Starting Repatha

After the first injection, most guidelines recommend a repeat fasting lipid panel at 4-12 weeks to confirm LDL-C response and guide any dose adjustments [3]. The FDA label for evolocumab notes that the maximum LDL-C lowering effect is generally seen within 4 weeks [1].

Liver enzyme monitoring (ALT, AST) is not mandated on the Repatha label at the same frequency as statin monitoring guidelines recommend, because evolocumab does not carry hepatotoxicity signals at the rates seen with high-intensity statins [1]. Standard clinical practice at most NH cardiology practices includes a lipid panel at 6-8 weeks post-initiation, then every 6-12 months if stable.

The GLAGOV trial (N=968) showed that evolocumab added to statin therapy reduced atheroma volume (percent atheroma volume: -0.95% evolocumab vs. +0.05% placebo, P<0.001) over 76 weeks, providing imaging-level evidence of plaque regression, not just LDL-C reduction [16]. Sharing this data with patients who ask whether the drug does anything beyond lowering a number on a lab report supports medication adherence.

Injection site reactions occur in approximately 2.1% of evolocumab patients versus 1.6% placebo in FOURIER [2]. Rotating injection sites (abdomen, thigh, upper arm) and allowing the autoinjector to reach room temperature for 30-45 minutes before injection reduces local discomfort.

Starting the Process: A Step-by-Step Summary for NH Residents

1. Order or locate a recent fasting lipid panel (within 90 days). If you do not have one, most NH urgent care labs or LabCorp/Quest locations can draw it without a physician order in NH.
2. Compile a medication history showing statin trials (drug name, dose, duration) and any documented intolerances.
3. Book a telehealth appointment with an NH-licensed provider (through HealthRX or another licensed NH telehealth platform) or an in-person cardiologist/PCP in NH.
4. At the visit, provide lipid panel results, statin history, and current cardiovascular diagnoses.
5. If your provider determines Repatha is indicated, the prescription routes to a specialty pharmacy for PA submission.
6. Enroll in the Amgen copay card or SUPPORTS program at the time of prescribing to prevent cost-related abandonment.
7. Expect 5-10 business days from PA approval to first delivery for standard cases; expedited PA can compress this to 3-5 business days.

Patients with LDL-C above 190 mg/dL at baseline (a common HeFH diagnostic threshold per the Dutch Lipid Clinic Network score) [17] are the most likely to qualify for PA approval on a first submission, since the clinical urgency is difficult for insurers to dispute at that LDL-C level.