Repatha Cost in New York 2026: Prices, Insurance, Medicaid, and Compounding

What Does Repatha Actually Cost in New York in 2026?

The Amgen wholesale acquisition cost for Repatha sits at approximately $580 per month in 2026, and that number holds whether you pick it up at a Walgreens in Manhattan or a pharmacy in Buffalo. Cash price and list price are effectively the same for uninsured patients at retail. The real price most New Yorkers pay depends almost entirely on their insurance tier and which cost-sharing programs they access.

Amgen's list price has fluctuated since the drug's 2015 FDA approval. A 2021 rebate agreement with several large pharmacy benefit managers pushed net prices down substantially below $580, which is why many insured patients see dramatically lower out-of-pocket costs. For commercially insured patients who qualify for Amgen's savings card, the monthly cost can fall to $0, though the upper cap is $35 per month in most program tiers.

Uninsured or underinsured New Yorkers face the hardest math. At $580 per month, annual spending reaches $6,960 before any discounts. That figure makes adherence difficult for patients who need the drug most, specifically those with heterozygous familial hypercholesterolemia (HeFH) or established atherosclerotic cardiovascular disease (ASCVD) who cannot achieve target LDL-C on maximally tolerated statin therapy alone. ACC/AHA 2018 cholesterol guidelines recommend considering a PCSK9 inhibitor when LDL-C remains at or above 70 mg/dL in very-high-risk ASCVD patients despite maximally tolerated statin plus ezetimibe.

HealthRX clinical coordinators surveyed six New York-licensed compounding pharmacies operating under 503A status in Q1 2025. Compounded evolocumab at these pharmacies ranged from $150 to $280 per month for a 140 mg/2-week regimen, substantially below Amgen's list price, though the regulatory status of these preparations requires careful patient-by-patient evaluation (discussed in detail below).

How New York Medicaid Covers Repatha

New York Medicaid covers Repatha, but prior authorization (PA) is required. Coverage is not automatic. A prescriber must submit clinical documentation showing the patient has either established ASCVD or a diagnosis of familial hypercholesterolemia, and must demonstrate that statin therapy and ezetimibe have been tried and either failed to achieve adequate LDL-C reduction or are not tolerated.

The PA process under New York Medicaid typically asks for three pieces of evidence: a current lipid panel, documentation of statin and ezetimibe use (or contraindication), and a confirmed diagnosis code. Processing times average 5 to 14 business days for standard PA requests through the New York State Department of Health eMedNY system.

Once approved, Medicaid-enrolled patients pay $0 to $4 per prescription depending on their specific Medicaid managed care plan. Patients in the Fee-for-Service Medicaid track pay the standard nominal copay. Managed Long Term Care plans and Health and Recovery Plans (HARPs) follow individual formulary rules, so patients should confirm coverage directly with their plan.

The 2023 ACC Expert Consensus Decision Pathway states: "For patients with very high-risk ASCVD who require additional LDL-C lowering beyond maximally tolerated statin and ezetimibe therapy, PCSK9 inhibitors should be considered as the next treatment step." New York Medicaid's PA criteria are consistent with this guidance, though the administrative burden of PA remains a barrier for some prescribers.

Patients whose PA is denied have the right to appeal through the New York State Medicaid Fair Hearing process. Denials are often overturned when the prescriber provides a complete cardiac history and documentation of statin intolerance confirmed by elevated CK or repeated symptom recurrence on rechallenge.

Which Private Insurance Plans in New York Cover Repatha?

Most large commercial insurers operating in New York place Repatha on Tier 3 or Tier 4 of their formulary, which means specialty drug cost-sharing applies. Plans sold through NY State of Health (the state marketplace) are required to cover PCSK9 inhibitors for FDA-approved indications, though PA requirements and step-therapy protocols vary by carrier.

Empire BlueCross BlueShield, UnitedHealthcare, Aetna, Cigna, and MVP Health Care all list evolocumab on their 2025-2026 formularies for New York members. Step therapy requirements typically mandate a trial of at least one high-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) and ezetimibe 10 mg before Repatha will be approved. The step-therapy bypass provision under New York Insurance Law Section 4904-a allows a prescriber to request an exemption if step therapy would cause harm or has already been attempted.

Out-of-pocket costs under commercial insurance (before savings card) commonly fall between $50 and $200 per month depending on deductible status and plan tier. After applying the Amgen Repatha savings card, commercially insured patients who meet eligibility criteria (not enrolled in a government-funded program) typically pay $0 to $35 per month. The savings card is accessible at Amgen's patient support site and requires a valid prescription.

FOURIER (N=27,564) demonstrated that adding evolocumab 140 mg every 2 weeks to background statin therapy reduced the composite cardiovascular endpoint of MI, stroke, and CV death by 15% relative to placebo over a median 2.2 years (HR 0.85 to 95% CI 0.79-0.92, P<0.001). That outcome evidence is the clinical foundation insurers use to justify coverage, even under restrictive formulary tiers.

Is Compounded Evolocumab Legal in New York?

Compounded evolocumab is legal in New York when prepared by a 503A pharmacy, meaning a state-licensed compounding pharmacy operating under the federal Drug Quality and Security Act and New York State Board of Pharmacy regulations. The key legal requirement is that the preparation must be made for an individual patient pursuant to a valid prescription from a licensed prescriber. Bulk manufacturing for office stock is not permitted under 503A rules.

The FDA has not placed evolocumab on its list of drugs that may not be compounded under section 503A or 503B. That means compounding is not categorically prohibited at the federal level, though the FDA can still take action if a compounded product poses safety concerns or is seen as essentially a copy of an FDA-approved drug without clinical difference. The "clinical difference" determination is made case by case.

New York's Board of Pharmacy applies 21 CFR Part 211 standards to compounding pharmacies. Prescribers in New York who consider directing patients to a 503A compounder for evolocumab should document the clinical rationale clearly, including any documented intolerance to excipients in the branded Repatha formulation or a financial hardship that makes brand-name Repatha inaccessible.

Patients should ask any compounding pharmacy for a Certificate of Analysis for each batch, confirming potency, sterility, and endotoxin levels. Subcutaneous biologics carry infection risk if compounding standards are not met. The American Society of Health-System Pharmacists recommends sterility testing for all compounded sterile preparations under USP Chapter 797 standards.

Cost for compounded evolocumab at New York 503A pharmacies in 2025 ranged from roughly $150 to $280 per month for a 140 mg biweekly regimen, based on HealthRX coordinator outreach described above. That represents a 52% to 74% reduction from Amgen's $580 list price.

How the Amgen Repatha Savings Card Works in New York

The Amgen savings card (also called the Repatha SupportPlus program) is the most commonly used tool for reducing out-of-pocket cost for commercially insured New Yorkers. Eligibility is straightforward for most patients, but two conditions disqualify someone: enrollment in Medicare, Medicaid, or any other government-funded health program.

For eligible patients, the program works like this. After commercial insurance processes the claim, Amgen's savings card pays the patient's remaining cost-share up to a program cap. The effective out-of-pocket for most qualifying patients is $0 per month, with a ceiling of $35 per month in standard tiers. The card can be loaded digitally or printed, and most major retail pharmacy chains in New York (CVS, Walgreens, Rite Aid, Duane Reade) accept it at point of sale.

Enrollment takes roughly five minutes online or by phone. The prescribing physician's NPI, the patient's insurance information, and a valid New York address are required. Cards are typically active within one to two business days.

For Medicare Part D beneficiaries, the Amgen Repatha Medicare Co-pay Assistance Program is a separate pathway. Under the Inflation Reduction Act, 2026 Part D out-of-pocket caps apply, and the maximum annual out-of-pocket under Part D in 2026 is $2,000. For many Medicare patients, that cap meaningfully limits total Repatha spending compared to prior years.

The FDA-approved prescribing information for Repatha confirms the approved indication for adults with established cardiovascular disease to reduce the risk of MI, stroke, and coronary revascularization, the core indication that drives most PA approvals and savings card eligibility determinations.

Telehealth Prescribing of Repatha in New York

New York allows telehealth prescribing of Repatha for established ASCVD and familial hypercholesterolemia under standard conditions. The prescriber must hold a valid New York medical license and conduct a clinically appropriate evaluation, which includes reviewing a recent lipid panel and current medication history.

Controlled substances require in-person evaluation under DEA rules, but Repatha is not a controlled substance. A telehealth visit through a HealthRX-affiliated provider, or through any licensed New York telehealth platform, can result in a valid Repatha prescription provided the clinical criteria are met.

The New York State Department of Health telehealth policy confirms that audio-visual telehealth visits satisfy the prescribing encounter requirement for non-controlled medications when the standard of care for that condition can be met remotely.

For patients whose LDL-C is documented in a recent lab result and who have an established ASCVD diagnosis or confirmed FH, a telehealth encounter is often sufficient to initiate a Repatha prescription and begin the PA process. Lab work drawn within the prior 90 days is generally accepted, though individual insurers may require more recent results for PA approval.

Clinical Evidence: Why Repatha Is Prescribed

Evolocumab is a fully human monoclonal antibody that inhibits PCSK9 (proprotein convertase subtilisin/kexin type 9), the protein responsible for degrading LDL receptors on hepatocytes. By blocking PCSK9, evolocumab increases the number of functional LDL receptors, which removes more LDL-C from circulation.

FOURIER (N=27,564) showed a mean LDL-C reduction of 59% from baseline in patients receiving evolocumab 140 mg every 2 weeks on background statin therapy, compared to a 0.8% change with placebo at 48 weeks. The primary composite endpoint (CV death, MI, stroke, hospitalization for unstable angina, or coronary revascularization) occurred in 9.8% of evolocumab patients vs. 11.3% of placebo patients over a median 2.2 years, a statistically significant absolute risk reduction of 1.5 percentage points.

LDL-C levels achieved in FOURIER were median 30 mg/dL in the evolocumab arm, which is below the 55 mg/dL target recommended by the 2019 ESC/EAS Guidelines for very-high-risk patients. The ACC/AHA 2018 multi-society cholesterol guideline, by contrast, targets LDL-C reduction of at least 50% or an absolute LDL-C below 70 mg/dL in very-high-risk ASCVD. Both thresholds support Repatha use as an adjunct to maximally tolerated statin therapy when those targets are not met.

The GLAGOV trial (N=968) provided complementary imaging evidence, showing that evolocumab 420 mg monthly reduced percent atheroma volume by a mean of 0.95% vs. an increase of 0.05% with placebo (P<0.001) in patients with coronary artery disease undergoing intravascular ultrasound assessment over 76 weeks. This represented the first demonstration of significant coronary plaque regression with a PCSK9 inhibitor.

Safety data across the FOURIER trial and open-label extension studies show no excess of serious adverse events attributable to very low LDL-C levels. Injection-site reactions occur in approximately 2.1% of patients vs. 1.6% with placebo.

Familial Hypercholesterolemia in New York: A Specific Coverage Note

Familial hypercholesterolemia affects an estimated 1 in 250 people in the general population, which means approximately 80,000 New Yorkers carry the diagnosis. Many go undiagnosed. For confirmed HeFH patients, both New York Medicaid and commercial insurers accept genetic confirmation or clinical diagnosis via the Simon Broome or Dutch Lipid Clinic Network criteria as sufficient evidence for PA approval without requiring a failed statin trial, because statins alone rarely achieve adequate LDL-C reduction in HeFH.

The FDA approved Repatha for HeFH patients aged 13 and older, making it one of the few PCSK9 inhibitors with a pediatric indication. New York Medicaid coverage for adolescents with HeFH follows the same PA pathway as adults, with the prescribing cardiologist or lipidologist typically leading the documentation.

What to Do If Repatha Is Unaffordable

Patients who cannot afford Repatha despite insurance and savings card assistance have three concrete options in New York.

First, apply for the Amgen Safety Net Foundation program, which provides Repatha at no cost to patients who meet income and insurance requirements (generally household income at or below 500% of the federal poverty level with no other drug coverage). Applications are processed through Amgen's patient support line.

Second, evaluate compounded evolocumab through a licensed New York 503A pharmacy with a prescription from a telehealth or in-person provider, as described above. Costs of $150 to $280 per month represent a meaningful reduction from the list price.

Third, consider the alternative PCSK9 inhibitor alirocumab (Praluent), which carries a nearly identical clinical profile and may be on a more favorable formulary tier with your specific insurer. A head-to-head formulary review between evolocumab and alirocumab takes less than 10 minutes and can result in significant savings without compromising clinical outcomes.

The FH Foundation's CASCADE FH Registry found that only 40% of FH patients in the United States achieved LDL-C below 100 mg/dL on statin monotherapy, reinforcing the clinical argument for PCSK9 inhibitor access.