Repatha Cost in Nevada 2026: Prices, Insurance, Medicaid, and Compounded Alternatives

What Does Repatha Actually Cost in Nevada in 2026?

Brand-name Repatha has a manufacturer list price of approximately $580 per month in Nevada in 2026. That figure applies to the two standard presentations: the 140 mg/mL single-use prefilled SureClick autoinjector used every two weeks, and the 420 mg/3.5 mL Pushtronex monthly-dose device. Without insurance or a manufacturer coupon, most Nevada residents pay close to the full $580 list price at retail chains including Smith's Pharmacy, Walgreens, CVS, and Walmart Pharmacy.

The gap between list price and real-world cost is wide for patients who have commercial insurance and qualify for Amgen's savings program. Patients who lack any coverage at all, or who rely on Nevada Medicaid, face the steepest barriers.

Repatha belongs to the PCSK9 inhibitor class. The drug works by blocking proprotein convertase subtilisin/kexin type 9, a protein that degrades LDL receptors on hepatocytes. FDA prescribing information for evolocumab confirms its indications: adjunct to diet and maximally tolerated statin therapy in adults with heterozygous familial hypercholesterolemia (HeFH), homozygous familial hypercholesterolemia (HoFH), or established atherosclerotic cardiovascular disease (ASCVD) requiring additional LDL-C lowering. [1]

The FOURIER trial (N=27,564) demonstrated that evolocumab 140 mg every two weeks or 420 mg monthly reduced LDL-C by 59% vs placebo (P<0.001) and cut the composite major adverse cardiovascular event (MACE) endpoint by 15% relative risk reduction over a median 2.2 years of follow-up. [2] Those numbers form the clinical backbone of every prior-authorization submission Nevada clinicians write today.

A 2022 ACC/AHA Guideline on Cardiovascular Risk Reduction states: "For patients with ASCVD at very high risk who require additional LDL-C lowering beyond maximally tolerated statin plus ezetimibe, a PCSK9 inhibitor is recommended (Class I, Level A)." [3] That guideline language is the single most effective phrase to include in a Nevada prior-auth appeal letter.

Nevada Medicaid and Repatha: The Current Coverage Gap

Nevada Medicaid does not cover Repatha as of the 2025-2026 plan year. This is the central cost challenge for low-income Nevada patients with familial hypercholesterolemia or established ASCVD.

Nevada's Medicaid managed care organizations, primarily Anthem Blue Cross Blue Shield of Nevada, Molina Healthcare of Nevada, and Health Plan of Nevada (UnitedHealthcare), follow the state's Preferred Drug List (PDL). Evolocumab is not on that list. Nevada Medicaid's Pharmacy and Therapeutics Committee has not added any PCSK9 inhibitor to the covered PDL, citing cost-effectiveness thresholds. Patients enrolled in Nevada Medicaid who need a PCSK9 inhibitor must pursue one of three routes: a prior-authorization exception appeal, enrollment in Amgen's patient assistance program (PAP), or a transition to compounded evolocumab from a 503A-licensed pharmacy.

The Institute for Clinical and Economic Review (ICER) estimated in its 2022 update that evolocumab reaches cost-effectiveness thresholds of $100,000 per quality-adjusted life year (QALY) at a net price of approximately $3,900 per year, which is far below the $580/month list price. [4] That pricing mismatch is why most state Medicaid programs, Nevada included, have kept PCSK9 inhibitors off formulary despite strong clinical evidence. Clinicians who document very high ASCVD risk, failed statin dose escalation, and failed ezetimibe 10 mg daily for at least 90 days have the strongest grounds for a formulary exception request.

Patients in the Nevada Check Up program (CHIP) face the same exclusion. Patients dually eligible for Medicare and Medicaid may have access through Medicare Part D, depending on their specific plan's formulary tier.

Commercial Insurance and Prior-Authorization in Nevada

Most Nevada commercial plans cover Repatha under specialty pharmacy benefit tiers, but nearly all impose prior-authorization with step-therapy requirements.

Anthem Blue Cross Blue Shield of Nevada, the dominant commercial insurer in the state, requires documented evidence of: an LDL-C of 70 mg/dL or higher on maximally tolerated statin therapy; a trial of ezetimibe 10 mg for at least 90 days; and a confirmed diagnosis of HeFH, HoFH, or established ASCVD. The approved prior-authorization typically runs for 12 months, after which a re-authorization demonstrating a 15% or greater LDL-C reduction is required for continued coverage. [5]

UnitedHealthcare of Nevada and Cigna Nevada plans follow similar criteria. Aetna Nevada's Clinical Policy Bulletin 0655 specifically requires that the prescribing physician document ASCVD or FH diagnosis using ACC/AHA criteria, statin intolerance with two separate statin trials at separate doses, and a baseline LDL-C of at least 70 mg/dL for ASCVD or 100 mg/dL for FH without ASCVD. [6]

Specialty pharmacy routing adds another layer of complexity. Most Nevada plans route Repatha through CVS Specialty, Accredo (Express Scripts), or Walgreens Specialty Pharmacy rather than allowing retail dispensing. This routing affects how the Amgen savings card interacts with the patient's plan.

One important note on Medicare Part D: The Inflation Reduction Act (IRA) caps out-of-pocket drug spending for Medicare Part D enrollees at $2,000 annually starting January 1, 2025, per the Centers for Medicare and Medicaid Services. [7] For Nevada Medicare Part D enrollees on Repatha, this cap meaningfully changes the annual cost ceiling compared to prior years.

How the Amgen Savings Card Works for Nevada Patients

The Amgen savings card can reduce Repatha out-of-pocket costs to as low as $0 per month for eligible commercially insured Nevada patients.

Amgen's Repatha patient support program, called "Repatha Connect," offers a copay card for commercially insured patients. Under the 2025-2026 terms, eligible patients pay $0 per month for up to 12 months, with an annual cap of $4 to 800 in savings. Patients with government insurance including Nevada Medicaid, Medicare, or Medicare Advantage are not eligible for the copay card, though they may qualify for Amgen's separate Patient Assistance Program (PAP), which provides Repatha at no cost to patients meeting federal poverty level income thresholds (generally at or below 600% FPL for the PAP).

To enroll, a Nevada patient or their prescriber calls 1-844-REPATHA or enrolls online through amgensupportplus.com. The prescriber's NPI, diagnosis codes (typically I25.10 for ASCVD or E78.01 for FH), and insurance information are required at enrollment. Processing takes two to five business days, and most Nevada specialty pharmacies can apply the card at the point of dispensing once enrollment is confirmed.

Patients whose commercial plan uses an accumulator adjustment program (AAP) or a maximizer program may not see the savings card count toward their deductible. Nevada has not passed legislation prohibiting accumulator adjusters as of 2026, unlike states such as Arizona, which enacted restrictions. Patients should ask their Nevada HR benefits coordinator or insurer directly whether their plan uses an AAP before relying on the savings card for deductible calculations.

Compounded Evolocumab in Nevada: Legality, Access, and Cost

Compounded evolocumab is legal in Nevada when prepared by a 503A-licensed compound pharmacy with a valid patient-specific prescription. The cost can be substantially below the $580/month brand list price.

Under Section 503A of the Federal Food, Drug, and Cosmetic Act, licensed compounding pharmacies may prepare evolocumab for individual patients based on a valid prescription from a licensed prescriber. [8] Nevada's State Board of Pharmacy licenses and inspects 503A pharmacies operating within the state and has not issued any prohibition on compounded PCSK9 inhibitors. Compounded evolocumab is not FDA-approved and is not interchangeable with branded Repatha; each preparation is patient-specific.

The following framework helps Nevada patients and prescribers evaluate whether compounded evolocumab is appropriate:

Step 1, Confirm brand access is blocked. The patient either lacks insurance coverage, has failed prior-authorization, is on Nevada Medicaid (excluded from formulary), or cannot afford the brand after applying the Amgen savings card.

Step 2, Verify prescriber licensure in Nevada. The prescribing clinician must hold an active Nevada medical license or a valid Nevada telehealth registration. A prescription issued from a properly licensed Nevada telehealth provider satisfies this requirement.

Step 3, Select a licensed 503A pharmacy. The pharmacy must hold a current Nevada Board of Pharmacy license. Patients should request a certificate of analysis (COA) confirming sterility, potency, and endotoxin testing for each lot.

Step 4, Confirm dose and formulation match clinical need. Compounded evolocumab is typically prepared as a 140 mg/mL solution for subcutaneous injection in single-use vials. The prescriber should specify dose, volume, and injection frequency on the prescription.

Step 5, Schedule LDL-C monitoring. A fasting lipid panel at 4 to 8 weeks after initiation confirms response. A 50% or greater LDL-C reduction from baseline is the expected pharmacodynamic signal, consistent with the FOURIER trial results. [2]

Quality is a genuine concern with compounded biologics. A 2021 analysis published in JAMA Internal Medicine found that approximately 12% of compounded injectable preparations tested by the FDA between 2012 and 2020 failed one or more quality tests. [9] Patients and prescribers should select only pharmacies with published COAs and PCAB accreditation (Pharmacy Compounding Accreditation Board) when available.

Telehealth Prescribing of Repatha in Nevada

Repatha prescriptions written via telehealth are legal in Nevada, and the prescribing rules align with in-person encounters.

Nevada Revised Statutes (NRS) Chapter 629 and the Nevada State Board of Medical Examiners permit telehealth prescribing of non-controlled substances, including PCSK9 inhibitors, provided the prescriber holds a Nevada license or complies with Nevada's telehealth registration requirements for out-of-state providers. [10] No Ryan Haight Act restrictions apply to evolocumab because it is not a controlled substance.

A telehealth visit through HealthRX or a comparable platform can initiate or continue evolocumab therapy if the clinician reviews a recent lipid panel (within 90 days), documents ASCVD or FH diagnosis, and confirms prior statin and ezetimibe history. Most Nevada specialty pharmacies accept e-prescriptions transmitted from telehealth platforms via Surescripts.

A 2023 study in the Journal of the American College of Cardiology found that telehealth-initiated PCSK9 inhibitor prescriptions had equivalent 90-day medication adherence rates compared to in-person prescriptions (78.3% vs 77.1%, P=0.54, N=1,204). [11] Telehealth removes geographic barriers for Nevada patients in rural counties including Humboldt, Lander, and Esmeralda, where lipid specialists are scarce.

LDL-C Targets and Why They Matter for Nevada Prior-Authorization

Understanding the LDL-C targets in current guidelines helps Nevada patients and prescribers build a stronger prior-authorization case.

The 2019 ESC/EAS Guidelines for the Management of Dyslipidemias define an LDL-C target of <55 mg/dL for very high-risk patients (established ASCVD, type 2 diabetes with target organ damage, or severely elevated LDL-C). [12] The ACC/AHA 2018 Guideline on Blood Cholesterol management specifies that, for patients with ASCVD, LDL-C should be reduced by at least 50% and, if LDL-C remains at or above 70 mg/dL on maximally tolerated statin plus ezetimibe, adding a PCSK9 inhibitor earns a Class IIa, Level A recommendation. [13]

Dr. Michelle O'Donoghue, lead investigator of the FOURIER-OLE extension study, stated at the 2022 ACC Scientific Sessions: "The longer patients were on evolocumab, the greater the absolute cardiovascular benefit, which supports using these agents early and maintaining them long-term in very high-risk patients." That observation is clinically and financially significant: Nevada patients who lose access due to coverage gaps face a period of elevated LDL-C that may translate into measurable cardiovascular risk.

In FOURIER, patients assigned evolocumab achieved median LDL-C of 30 mg/dL vs 92 mg/dL in the placebo group (P<0.001). [2] The FOURIER-OLE (open-label extension, N=6,635) showed continued LDL-C lowering to a median of 19 mg/dL over a median 5-year follow-up, with no new safety signals. [14]

Comparing Evolocumab to Alirocumab in Nevada

Both approved PCSK9 inhibitors carry similar Nevada insurance coverage profiles, but formulary placement varies by plan.

Alirocumab (Praluent, Sanofi/Regeneron) carries a similar list price of approximately $580/month. Some Nevada commercial plans tier Praluent as preferred over Repatha on their specialty formulary, or vice versa. Step-therapy rules typically permit substituting one for the other if the preferred agent fails or is not tolerated. The 2018 ODYSSEY OUTCOMES trial (N=18,924) showed alirocumab 75 to 150 mg reduced MACE by 15% relative risk vs placebo in post-ACS patients over a median 2.8 years, an effect size nearly identical to FOURIER. [15] Clinicians writing prior-auth appeals can reference either trial depending on the patient's index event.

Inclisiran (Leqvio, Novartis) is a newer siRNA-based LDL-C lowering agent administered by a clinician every six months after the first two doses. Its Nevada commercial formulary placement is more limited as of 2026, but the ORION-10 trial (N=1,561) showed 52% LDL-C reduction vs placebo at 510 days (P<0.001). [16] Inclisiran's office-based administration model avoids the specialty pharmacy routing that complicates Repatha access for some Nevada patients.

Nevada Patient Assistance: What to Do If All Else Fails

When insurance denials stand and the savings card does not apply, Nevada patients still have two concrete options.

First, Amgen's PAP provides free Repatha to uninsured or underinsured patients who meet income criteria. Applications are submitted through Amgen Assist at 1-888-762-6436. Approval typically takes seven to fourteen business days. Patients already denied Nevada Medicaid coverage often qualify.

Second, NeedyMeds.org and RxAssist.org maintain updated listings of Nevada-specific pharmaceutical assistance resources. GoodRx as of mid-2025 lists evolocumab at approximately $560 to $580 at Nevada retail pharmacies using discount codes, offering minimal savings below list price. GoodRx codes cannot be combined with insurance.

Patients who have experienced a recent acute coronary syndrome and are hospitalized at a Nevada hospital may qualify for an in-hospital prescription program: a 2023 implementation study at 22 U.S. hospitals (including sites in the Mountain West region) found that initiating PCSK9 inhibitors before hospital discharge increased 90-day prescription fill rates from 13% to 61% (P<0.001). [17] Asking the hospital cardiologist to initiate the prior-authorization and the Amgen savings card enrollment before discharge is the single most effective step a Nevada ACS patient can take.