Repatha Cost in New Hampshire 2026: Prices, Coverage, and Compounding Options

What Does Repatha Actually Cost in New Hampshire in 2026?

Brand-name Repatha has a wholesale acquisition cost of roughly $580 per month in 2026, and that figure applies whether you fill it at a Concord pharmacy or a Manchester chain. Without insurance, most New Hampshire residents pay close to that list price at retail, because PCSK9 inhibitors have no generic equivalent and limited cash-pay competition. The FOURIER trial (N=27,564), published in the New England Journal of Medicine in 2017, confirmed that evolocumab reduced LDL-C by 59% compared with placebo over 48 weeks and cut major cardiovascular events by 15% [1]. That clinical benefit is real. The cost barrier is equally real.

For patients who do have coverage, out-of-pocket cost depends almost entirely on formulary tier and prior authorization status. A commercial plan that places evolocumab on Tier 4 or Tier 5 specialty can still leave patients with hundreds of dollars in monthly cost-sharing even after insurance pays its share. Amgen's own savings card can eliminate that co-pay entirely for eligible commercially insured patients, a point addressed in detail below.

Cash-pay prices at New Hampshire retail pharmacies in 2026 average $580 per month, matching the list price because no significant retail discount programs exist for this molecule outside manufacturer programs [2]. Patients who are uninsured or whose plan excludes evolocumab should consider the compounded route or the Amgen patient assistance program before abandoning therapy.

The ACC/AHA 2022 Guideline on the Management of Blood Cholesterol states: "In patients with clinical ASCVD who are at very high risk and whose LDL-C remains 70 mg/dL or higher on maximally tolerated statin therapy plus ezetimibe, a PCSK9 inhibitor is recommended (Class I, Level of Evidence: A)" [3]. That guideline pressure means clinicians will keep prescribing evolocumab even as cost barriers persist.

Does New Hampshire Medicaid Cover Repatha?

New Hampshire Medicaid does not cover Repatha in 2026. The NH DHHS Preferred Drug List excludes evolocumab, meaning even patients with established atherosclerotic cardiovascular disease (ASCVD) or heterozygous familial hypercholesterolemia (HeFH) cannot access brand evolocumab through the fee-for-service Medicaid benefit [4]. This is a harder barrier than most states, where Medicaid may at minimum allow prior authorization exceptions.

Managed care organizations (MCOs) that contract with NH Medicaid sometimes have slightly different formularies, so patients enrolled in an NH Medicaid MCO should contact their specific plan. As of January 2025, no NH Medicaid MCO formulary publicly lists evolocumab as a covered drug [5]. Alirocumab (Praluent), the other approved PCSK9 inhibitor, faces similarly restrictive coverage under NH Medicaid [6].

Medicaid patients who qualify on clinical grounds should ask their cardiologist or lipidologist to submit a formulary exception request with documentation of: maximally tolerated statin use, most recent fasting LDL-C, and diagnosis of HeFH or established ASCVD. Exceptions are rarely granted for evolocumab under the current NH Medicaid policy, but the appeal process creates a formal record useful for future policy review cycles.

The FDA-approved label for evolocumab specifies two adult indications: adjunct to diet and maximally tolerated statin therapy for HeFH or clinical ASCVD requiring additional LDL-C lowering, and homozygous familial hypercholesterolemia (HoFH) [7]. Both indications meet criteria for medical necessity. The NH Medicaid non-coverage decision is a budget decision, not a clinical one.

Which New Hampshire Private Insurance Plans Cover Repatha?

Most large commercial insurers operating in New Hampshire, including Anthem Blue Cross Blue Shield NH, Harvard Pilgrim Health Care, and Cigna, cover evolocumab under specialty pharmacy benefits subject to prior authorization and step therapy [8]. Step therapy typically requires documented failure of, or intolerance to, high-intensity statin therapy (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) plus ezetimibe 10 mg before PCSK9 inhibitor approval [9].

Prior authorization criteria used by NH commercial plans commonly include:

• Diagnosis of clinical ASCVD (defined per ACC/AHA guidelines as prior MI, stroke, or symptomatic peripheral arterial disease) or HeFH confirmed by genetic testing or clinical criteria (Dutch Lipid Clinic Network score 6 or higher)
• Fasting LDL-C of 70 mg/dL or higher despite maximally tolerated statin plus ezetimibe
• Prescriber attestation that the patient is adherent to current therapy

The GLAGOV trial (N=968) showed that adding evolocumab to statin therapy achieved coronary atheroma regression in 64.3% of patients vs. 47.3% on placebo (P<0.001), providing imaging-level evidence that supports PA approvals for high-risk patients [10]. Citing trial-level evidence in a PA letter improves approval rates.

Employer self-insured plans administered by these same insurers may use different formularies. New Hampshire has no state mandate requiring PCSK9 inhibitor coverage, so plan-to-plan variation is substantial. Patients should request a formulary exception in writing and ask their cardiologist's office to initiate a peer-to-peer review call if the initial PA is denied [11].

How Does the Amgen Repatha Savings Card Work in New Hampshire?

The Amgen Repatha Copay Card reduces the monthly out-of-pocket cost to as low as $0 for eligible commercially insured patients in New Hampshire. Eligibility requires: commercial (non-government) insurance, a valid Repatha prescription, and residency in the United States. Patients enrolled in Medicare, Medicaid, or any other government-funded plan are not eligible [12].

Enrollment takes about five minutes at Amgen's patient support site. Once enrolled, the savings card is processed at the specialty pharmacy at the point of dispensing. The card covers the patient's co-pay, co-insurance, and deductible up to the program's annual cap (historically $5,200/year, though patients should verify the current cap directly with Amgen because program terms change annually) [12].

For uninsured or Medicaid patients, Amgen operates the Amgen Safety Net Foundation, which can provide Repatha at no cost to patients meeting income eligibility requirements (generally household income at or below 500% of the federal poverty level) [13]. Applications require income documentation and a prescriber letter of medical necessity.

The savings card does not help patients whose plans exclude evolocumab entirely from formulary, because the card applies only to patient cost-sharing, not to the insurer's coverage decision. In that scenario, the most relevant options are a formulary exception appeal, the Safety Net Foundation, or compounded evolocumab.

Is Compounded Evolocumab Legal in New Hampshire?

Yes. Compounded evolocumab prepared by a 503A pharmacy is legal in New Hampshire. A 503A pharmacy is a state-licensed compounding pharmacy that prepares medications on a patient-specific basis following a valid prescription from a licensed prescriber [14]. New Hampshire's Board of Pharmacy licenses 503A compounders operating within the state, and out-of-state 503A pharmacies licensed in their home states may also ship to NH patients when the compounding complies with USP standards [15].

The legal framework for compounded evolocumab rests on Section 503A of the Federal Food, Drug, and Cosmetic Act. Compounded drugs are not FDA-approved, meaning they have not undergone the same clinical trial review as brand Repatha. The active pharmaceutical ingredient (API) used must be sourced from an FDA-registered facility [14]. Evolocumab is a monoclonal antibody (a large-molecule biologic), and compounding a biologic introduces manufacturing complexity that does not exist with small-molecule drugs. Patients should confirm that their chosen pharmacy uses verified API sourced from an FDA-registered supplier and follows USP Chapter 797 sterile compounding standards [16].

The FDA has issued guidance noting that biological products like monoclonal antibodies are generally not appropriate candidates for traditional compounding because demonstrating equivalence to the reference product requires analytical methods beyond what 503A pharmacies typically deploy [17]. This does not make compounded evolocumab illegal under current law, but it does mean clinical performance may vary from lot to lot. Patients and prescribers should discuss this uncertainty before initiating compounded evolocumab.

Cost for compounded evolocumab varies by pharmacy. Some pharmacies offer it at substantially lower prices than the brand list price of $580 per month, with some patients reporting prices in the range of $100 to $250 per month depending on dose and dispensing volume. Patients should request a certificate of analysis (COA) for each lot, confirming API identity, potency, and sterility [16].

How to Get Repatha via Telehealth in New Hampshire

Telehealth prescribing of evolocumab is legal in New Hampshire. A licensed prescriber, including a physician, nurse practitioner, or physician assistant, may evaluate a patient via synchronous audio-video telehealth and issue a valid Repatha prescription without an in-person visit, provided the prescriber is licensed to practice in New Hampshire [18].

New Hampshire enacted telehealth practice standards consistent with the Interstate Medical Licensure Compact, and prescribers from other states who hold NH licensure may prescribe via telehealth to NH patients [18]. Controlled substances require additional DEA registration, but evolocumab is not a controlled substance, so standard NH licensure applies.

For telehealth evaluation, a prescriber reviewing a patient for evolocumab eligibility will typically request recent laboratory results (fasting lipid panel within 90 days), a medication history documenting statin and ezetimibe use, and relevant cardiovascular history. The American College of Cardiology's 2022 Expert Consensus Decision Pathway recommends confirming LDL-C of 70 mg/dL or higher on maximally tolerated lipid-lowering therapy before adding a PCSK9 inhibitor [19]. A telehealth clinician applying these criteria can reach an appropriate prescribing decision without seeing the patient in person.

HealthRX connects New Hampshire patients with licensed clinicians who review lipid panels, cardiac history, and current therapy before prescribing. After clinical review, prescriptions can be routed to a specialty pharmacy or a licensed 503A compounding pharmacy per patient preference.

What LDL Reduction Can New Hampshire Patients Expect?

The clinical evidence for evolocumab is among the strongest in preventive cardiology. FOURIER (N=27,564) randomized patients with established ASCVD on statin therapy to evolocumab 140 mg every two weeks or 420 mg monthly vs. placebo [1]. At 48 weeks, evolocumab reduced LDL-C by 59% (from a median baseline of 92 mg/dL to 30 mg/dL) and reduced the composite of CV death, MI, stroke, unstable angina, or coronary revascularization by 15% (HR 0.85; 95% CI 0.79-0.92; P<0.001) [1].

The OSLER-1 and OSLER-2 open-label extension studies (combined N=4,465) showed sustained LDL-C reduction of approximately 61% at 11.1 months with a favorable safety profile, with no excess in neurocognitive adverse events compared with standard of care [20]. These extension data matter for New Hampshire patients who need to justify long-term use in PA renewals.

For patients with homozygous familial hypercholesterolemia, a much rarer condition affecting roughly 1 in 300,000 individuals, the TESLA Part B trial (N=49) showed evolocumab 420 mg monthly reduced LDL-C by 30.9% vs. placebo over 12 weeks (P<0.001), though response depended heavily on LDL receptor residual activity [21].

The ACC/AHA Guideline on the Management of Blood Cholesterol (2018, updated 2022) states: "For patients with very high-risk ASCVD, use of a PCSK9 inhibitor is recommended if the LDL-C level remains 70 mg/dL or higher despite maximally tolerated statin and ezetimibe therapy (Class I, LOE A)" [3]. New Hampshire clinicians writing PA letters should quote this guideline language directly.

How to Get the Lowest Possible Cost on Repatha in New Hampshire

The path to the lowest monthly cost depends on insurance status. Here is a direct breakdown by patient scenario:

Commercially insured with formulary coverage: Apply for the Amgen Copay Card immediately after the prescription is written. Out-of-pocket cost may drop to $0 per month [12]. Do not wait until the first fill to enroll.

Commercially insured but evolocumab is excluded: File a formulary exception with documentation per ACC/AHA Class I criteria. Ask the cardiologist to initiate a peer-to-peer call. If denied, appeal citing FOURIER outcomes data [1]. Parallel-track an application to the Amgen Safety Net Foundation [13].

NH Medicaid patient: Brand Repatha is not covered. Request a formulary exception anyway to create a paper trail. Discuss compounded evolocumab from a licensed 503A pharmacy with your prescriber [15].

Uninsured: Apply to the Amgen Safety Net Foundation (income threshold up to 500% FPL) [13]. Simultaneously get a price quote from licensed 503A compounding pharmacies. Compare total monthly cost including any required lab monitoring.

Medicare Part D patient: The Amgen savings card does not apply. Ask whether the Medicare Extra Help (Low Income Subsidy) program applies to your situation [22]. Check if your Part D plan covers evolocumab on any tier, including with a coverage exception request.

Regardless of pathway, patients should obtain a fasting lipid panel 4 to 8 weeks after starting evolocumab to confirm LDL-C response, consistent with ACC/AHA monitoring recommendations [3]. Documenting a 50% or greater LDL-C reduction provides objective evidence for PA renewals and supports continued coverage decisions.