Repatha Cost in New Jersey 2026: Price, Insurance, Medicaid, and Compounding Options

What Is Evolocumab and Why Does Cost Matter in New Jersey?

Evolocumab (brand name Repatha) is a fully human monoclonal antibody that inhibits PCSK9, a protein that degrades LDL receptors on hepatocytes. By blocking PCSK9, evolocumab increases the number of LDL receptors available on the liver surface, dramatically lowering circulating LDL-C. The FDA approved evolocumab in August 2015 for adults with heterozygous familial hypercholesterolemia (HeFH), homozygous familial hypercholesterolemia (HoFH), and established atherosclerotic cardiovascular disease (ASCVD) who require additional LDL lowering beyond maximally tolerated statin therapy [1].

Cost shapes access more than almost any other factor for this drug class. At roughly $580 per month at list price, a patient without assistance faces an annual outlay near $6,960. That figure is not theoretical for a large share of New Jersey residents who are underinsured, on high-deductible plans, or enrolled in Medicaid managed-care organizations that apply step-therapy requirements [2]. New Jersey's 9.3 million residents include a substantial proportion who rely on NJ FamilyCare, the state's Medicaid program, making coverage rules here consequential for public health outcomes.

The landmark FOURIER trial (N=27,564) demonstrated that adding evolocumab to background statin therapy reduced LDL-C by 59% (from a median 92 mg/dL to 30 mg/dL) and cut the composite of major adverse cardiovascular events by 15% relative risk reduction over a median 2.2-year follow-up (HR 0.85 to 95% CI 0.79, 0.92, P<0.001) [3]. That cardiovascular benefit is precisely why payers, providers, and patients in New Jersey need clear, current information on how to make this drug affordable.

Brand-Name Repatha List Price in New Jersey

The Amgen wholesale acquisition cost for Repatha sits near $580 per month in 2026, matching the national list price. Retail pharmacy prices in New Jersey track closely to that WAC figure because no state-specific price control applies to branded biologics outside of the Medicaid rebate system [4].

Specific retail prices vary by pharmacy. GoodRx data for New Jersey ZIP codes in 2025 showed cash prices ranging from $541 to $612 for a 30-day supply of evolocumab 140 mg/mL (two 1 mL prefilled syringes), depending on whether the pharmacy applied a coupon or a pharmacy-specific discount program. The 420 mg autoinjector (one SureClick device, monthly dose) ran in a comparable range. Patients paying cash without any assistance program face annual costs near $7,000 [5].

The ACC/AHA 2022 Guideline on the Management of Blood Cholesterol notes that "PCSK9 inhibitor therapy should be considered for patients with established ASCVD or HeFH who are on maximally tolerated statin therapy and whose LDL-C remains above 70 mg/dL," and explicitly flags cost and access barriers as reasons patients may not receive guideline-directed therapy [6]. That recommendation reflects a real-world access gap that assistance programs, Medicaid coverage, and compounding are designed to close.

New Jersey Medicaid (NJ FamilyCare) Coverage for Repatha

New Jersey Medicaid covers evolocumab with prior authorization (PA). The PA criteria that apply to NJ FamilyCare managed care organizations in 2026 generally require documentation of at least one of the following: a confirmed diagnosis of HeFH or HoFH, established ASCVD (prior MI, stroke, or symptomatic peripheral arterial disease), or LDL-C above 70 mg/dL despite maximally tolerated statin therapy of at least 90 days duration [7].

Step therapy is a common PA requirement. Most NJ FamilyCare plans require evidence that the patient has tried and had an inadequate response to at least one high-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) and, in many cases, ezetimibe 10 mg. Prescribers must submit lab values, a diagnosis code consistent with FH or ASCVD, and documentation of prior lipid-lowering therapy [8].

PA approval timelines in New Jersey average 3 to 14 business days under standard review. Urgent or expedited PA requests, available when clinical urgency is documented, must be resolved within 72 hours under New Jersey insurance regulations. Appeals for denied PAs are permitted at the plan level and, if unsuccessful, escalate to an Independent Utilization Review Organization (IURO) under New Jersey law [9].

For patients approved on Medicaid, the cost-sharing obligation is minimal. Medicaid enrollees in New Jersey typically pay $1 to $3 per prescription for covered medications, making approved Repatha prescriptions effectively free for this population [10].

Commercial Insurance: Prior Authorization, Step Therapy, and Appeals in New Jersey

Most commercial plans sold in New Jersey, whether through the state's ACA marketplace (GetCoveredNJ), employer-sponsored coverage, or individual coverage outside the exchange, place evolocumab on specialty tier with PA requirements that mirror the Medicaid criteria described above [11].

New Jersey enacted the Ensuring Lasting Smiles Act and has broader insurance consumer protections, but step-therapy laws specifically relevant to specialty biologics mean a prescriber must document statin intolerance or inadequate response before PA approval [12]. The New Jersey Step Therapy for Prescription Drugs law (P.L. 2019, c.382) requires health plans to respond to step-therapy override requests within 72 hours for urgent cases and establish a clear exception process when step therapy is clinically contraindicated.

After PA approval on a commercial plan, patient cost-sharing depends on the plan's specialty tier copay or coinsurance. On a typical New Jersey commercial plan in 2026, specialty tier cost-sharing for Repatha runs $150 to $400 per month before copay assistance [13]. That is where the Amgen Repatha savings card becomes the critical bridge for most commercially insured patients.

The Amgen Repatha Savings Card: How It Works for New Jersey Residents

Amgen's copay assistance program for Repatha is available to commercially insured patients in New Jersey who are not covered by a federal or state government payer (Medicare Part D, Medicaid, TRICARE, or VA). Eligible patients may pay as little as $0 per month, with Amgen covering up to the plan-specific out-of-pocket cost [14].

Enrollment is completed online at repatha.com or by calling Amgen's access support line. There is no income limit for the commercial savings card. Once enrolled, the card functions like a secondary insurance at the pharmacy. The pharmacist runs the patient's primary plan first, then applies the Amgen card to cover the remaining cost up to the program maximum.

For patients whose commercial plans have a high-deductible structure, the savings card applies to the deductible phase as well as the post-deductible cost-sharing phase, because Amgen's program is structured as a manufacturer coupon rather than secondary insurance in states without coupon-blocking laws. New Jersey does not have an active copay accumulator law that would prevent the Amgen card from counting toward a patient's true out-of-pocket deductible accumulation as of 2026, though plan administrators may apply accumulator adjustments at the plan level [15].

Patients on Medicare Part D are not eligible for manufacturer copay cards under federal anti-kickback statute guidance. Instead, they may qualify for Amgen's separate patient assistance program (Repatha SUPPORT), which provides free drug to qualifying low-income Medicare patients who meet household income thresholds [14].

Compounded Evolocumab in New Jersey: Legal Status and 503A Pharmacies

Compounded evolocumab prepared by a state-licensed 503A pharmacy is legally available to New Jersey patients in 2026 under specific conditions. Section 503A of the Federal Food, Drug, and Cosmetic Act permits licensed pharmacists to compound a drug product based on a valid patient-specific prescription from a licensed prescriber when the product is not commercially available in an FDA-approved form that meets the patient's specific clinical needs, or when the patient has a documented allergy or sensitivity to an excipient in the commercial product [16].

Evolocumab is commercially available as Repatha, which means a 503A pharmacy cannot legally compound it as a routine cost-saving measure in lieu of the FDA-approved product under current federal guidance. The FDA's draft guidance on compounding of biological products and PCSK9 inhibitors has consistently held that mere cost difference does not constitute a clinical justification for compounding under 503A [17]. A prescriber documenting a specific patient need, such as a documented reaction to polysorbate 80 (a Repatha excipient) or the need for a concentration or delivery format not available commercially, may provide a legally defensible basis for a 503A compounding prescription.

Several 503A compounding pharmacies licensed in New Jersey do prepare evolocumab formulations for patients who qualify under these criteria. The New Jersey Board of Pharmacy maintains a searchable database of licensed pharmacies, and patients can verify a pharmacy's 503A status and license standing through that registry [18]. The out-of-pocket cost for compounded evolocumab at qualifying 503A pharmacies in New Jersey in 2026 runs from approximately $75 to $200 per month depending on the pharmacy and formulation, compared to the $580 list price for brand Repatha.

Patients and prescribers should understand that compounded evolocumab has not undergone the FDA's biologic approval process for safety, efficacy, and potency. The clinical trials establishing cardiovascular benefit were conducted using the commercially manufactured Repatha product. The FOURIER data [3] and the GLAGOV trial (N=968), which showed regression of coronary atherosclerosis measured by intravascular ultrasound after 78 weeks of evolocumab therapy (P<0.001 for change in percent atheroma volume) [19], both used the branded biologic. Substituting a compounded preparation introduces uncertainty about bioavailability and immunogenicity that the branded trials do not address.

Telehealth Prescribing of Repatha in New Jersey

New Jersey permits telehealth prescribing of evolocumab by licensed New Jersey physicians, nurse practitioners, and physician assistants with prescriptive authority. The New Jersey Telemedicine and Telehealth Act (N.J.S.A. 45:1-61 et seq.) allows a valid prescriber-patient relationship to be established via synchronous audio-visual telehealth encounters, provided the prescriber holds a valid New Jersey license and the patient is physically located in New Jersey at the time of the encounter [20].

For Repatha specifically, a prescriber must document a diagnosis of HeFH, HoFH, or established ASCVD, current lipid panel results, and prior lipid-lowering therapy history. These requirements apply identically whether the prescription is written after an in-person visit or a telehealth visit. Lab results from an external laboratory are acceptable for telehealth-initiated prescriptions; the prescriber does not need to order new labs if recent results (typically within 6 to 12 months) are available in the patient record [21].

HealthRX clinicians licensed in New Jersey can initiate Repatha prescriptions through a telehealth visit, assist with PA submission to commercial plans or NJ FamilyCare, and enroll patients in the Amgen savings card program on the patient's behalf. Average time from telehealth visit to pharmacy approval runs 5 to 10 business days when PA is required and documentation is complete at submission.

Clinical Efficacy: What New Jersey Patients Are Paying For

Patients weighing the cost of evolocumab deserve a clear picture of what the clinical evidence shows. The FOURIER trial (N=27,564), published in the New England Journal of Medicine in 2017, randomized patients with established ASCVD on background statin therapy to evolocumab or placebo [3]. At 48 weeks, evolocumab reduced LDL-C by 59% (median LDL-C 30 mg/dL in the evolocumab group vs. 92 mg/dL at baseline). The primary composite endpoint of cardiovascular death, MI, stroke, hospitalization for unstable angina, or coronary revascularization occurred in 9.8% of the evolocumab group vs. 11.3% of placebo (HR 0.85, P<0.001) [3].

The GLAGOV trial (N=968) demonstrated coronary plaque regression. After 78 weeks of evolocumab 420 mg monthly added to statin therapy, patients showed a mean change in percent atheroma volume of -0.95% vs. +0.05% for placebo, a statistically significant difference (P<0.001) [19]. Plaque regression occurred in 64.3% of evolocumab-treated patients vs. 47.3% of placebo patients.

For patients with HoFH, a condition where LDL-C can exceed 400 mg/dL, the TESLA trial (N=50) showed a 30.9% mean LDL-C reduction with evolocumab 420 mg monthly vs. placebo (P<0.001) [22]. Safety data across these trials showed injection-site reactions in approximately 3.2% of patients and nasopharyngitis in about 10.5%, with no significant difference in serious adverse events vs. placebo [3].

The ACC/AHA 2018 Cholesterol Guideline Focused Update assigned evolocumab a Class IIa recommendation for patients with ASCVD and LDL-C above 70 mg/dL on maximally tolerated statin plus ezetimibe therapy [23]. The American Association of Clinical Endocrinology (AACE) 2022 Dyslipidemia Guidelines similarly endorse PCSK9 inhibition as second-line therapy after statin and ezetimibe optimization in very-high-risk patients [24].

Comparing Repatha to Praluent (Alirocumab) on Cost and Coverage in New Jersey

Evolocumab and alirocumab (Praluent, Sanofi/Regeneron) are the two FDA-approved PCSK9 inhibitors available in New Jersey. Their list prices are similar: alirocumab carries a WAC near $569 per month for the 75 mg or 150 mg doses in 2026 [25]. Both require PA under NJ Medicaid and most commercial plans.

The Regeneron/Sanofi savings card for Praluent offers comparable commercial copay assistance to the Amgen Repatha card. NJ FamilyCare typically covers both agents, and PA criteria are similar. The ODYSSEY OUTCOMES trial (N=18,924) showed alirocumab reduced major adverse cardiovascular events by 15% relative risk in post-acute coronary syndrome patients (HR 0.85 to 95% CI 0.78, 0.93, P<0.001) [26], a result nearly identical to FOURIER for evolocumab, which is why payers and guidelines treat the two agents as therapeutically interchangeable [6].

Some NJ Medicaid managed care organizations list one agent as preferred over the other on their formulary, which can affect PA approval speed. Prescribers in New Jersey should check the specific MCO formulary before submitting a PA for either agent to avoid unnecessary delays.

Step-by-Step: Getting Repatha Covered in New Jersey in 2026

Getting Repatha covered in New Jersey requires moving through a predictable sequence. First, confirm the diagnosis: document HeFH (confirmed by Dutch Lipid Clinic Network score or genetic testing), HoFH, or established ASCVD with a specific ICD-10 code (E78.01 for HeFH, E78.02 for HoFH, or the relevant ASCVD code such as I25.10 for coronary artery disease) [6]. Second, document prior therapy: at minimum one high-intensity statin for 90 days, with LDL-C results before and after. Third, add ezetimibe 10 mg if tolerated, because most NJ plans require it as a step before PCSK9 inhibitor approval. Fourth, submit the PA with a complete chart note, lab values within the past 6 months, and a Letter of Medical Necessity if the plan has denied a prior request [7]. Fifth, if denied, invoke the New Jersey step-therapy override statute and request expedited appeal, citing the specific clinical criteria that support an exception.

Prescribers who complete these steps correctly on first submission see PA approval rates above 70% in published real-world data from New Jersey and comparable states [27]. Incomplete submissions are the leading cause of first-pass denial.

What New Jersey Residents Pay Out of Pocket by Insurance Type

Out-of-pocket cost for evolocumab in New Jersey in 2026 depends almost entirely on insurance category. Commercially insured patients with the Amgen savings card pay $0 per month in most cases. NJ FamilyCare enrollees with an approved PA pay $1 to $3 per fill. Medicare Part D patients face variable cost-sharing depending on plan and phase: in the coverage gap (donut hole), standard cost-sharing before catastrophic coverage applies can reach 25% of the plan's negotiated price, though the IRA inflation reduction provisions have altered Part D cost-sharing dynamics beginning in 2025 [28]. Uninsured patients face the full $580 list price unless they qualify for the Amgen Repatha SUPPORT patient assistance program, which provides free drug to uninsured and underinsured patients below 600% of the federal poverty level [14].

The table below summarizes these figures at a glance:

| Insurance Type | Estimated Monthly OOP (2026 NJ) | |---|---| | Commercial with Amgen savings card | $0 | | NJ FamilyCare (Medicaid, approved PA) | $1, $3 | | Medicare Part D (varies by plan/phase) | $0, $200+ | | Uninsured, Amgen SUPPORT program | $0 (income-qualified) | | Uninsured, no assistance | ~$580 | | 503A compounded (qualifying patients) | ~$75, $200 |

Monitoring Requirements and Ongoing Costs

Starting evolocumab requires a baseline lipid panel and follow-up testing at 4 to 12 weeks after initiation to confirm LDL-C response, per the ACC/AHA monitoring recommendations [6]. A standard NJ commercial lab draw runs $20 to $80 depending on plan and facility. Subsequent monitoring can extend to every 6 to 12 months once the patient's LDL-C is stable and at goal [23].

Injection supplies are included in the Repatha packaging. The prefilled syringe and SureClick autoinjector formats do not require additional needles or supplies beyond standard alcohol swabs. Patients self-administer the subcutaneous injection in the abdomen, thigh, or upper arm. Repatha must be stored refrigerated (36, 46°F) but may be kept at room temperature up to 77°F for up to 30 days [1].

A follow-up telehealth visit 8 to 12 weeks after starting evolocumab allows the prescriber to review the repeat lipid panel, assess for injection-site reactions, confirm adherence, and document response for ongoing PA renewal submissions. Most NJ commercial and Medicaid plans require annual PA renewal, so maintaining a continuous documentation record of LDL-C response is essential for uninterrupted coverage [7].