Repatha Cost in Oregon 2026: Prices, Insurance, Medicaid, and Compounded Options

What Is the Actual Price of Repatha in Oregon in 2026?

The wholesale acquisition cost (WAC) for evolocumab (Repatha) sits at approximately $580 per month in 2026, a figure that applies uniformly across U.S. states including Oregon. That WAC number rarely reflects what any individual patient pays at the pharmacy counter. Insurance negotiated rates, mandatory rebates under Oregon's drug price transparency law, manufacturer assistance programs, and compounding each push the real out-of-pocket cost well below the sticker price for most patients.

The $580/month figure covers either the 140 mg/mL auto-injector used on a twice-monthly schedule or the 420 mg Pushtronex on-body device used once monthly. Both formulations deliver clinically equivalent LDL-C lowering. The FDA approved Repatha in August 2015 for heterozygous familial hypercholesterolemia (HeFH), homozygous familial hypercholesterolemia (HoFH), and established atherosclerotic cardiovascular disease (ASCVD) requiring additional LDL-C reduction beyond maximally tolerated statin therapy [1].

Oregon does not add a state drug surcharge on top of WAC, so list-price parity with the national average holds. The meaningful cost variation inside Oregon comes from which payer covers the patient, whether a prior authorization is approved, and whether the prescriber is aware of compounding alternatives.

The FOURIER trial (N=27,564), published in the New England Journal of Medicine in 2017, showed that adding evolocumab to statin therapy reduced LDL-C by a mean of 59% (from 92 mg/dL to 30 mg/dL) and cut the composite risk of cardiovascular death, myocardial infarction, or stroke by 15% relative to placebo over a median follow-up of 2.2 years (P<0.001) [2]. That clinical magnitude is the foundation every payer uses to justify coverage, and Oregon payers follow national precedent closely.

How Oregon Medicaid (Oregon Health Plan) Covers Repatha

Oregon Health Plan (OHP) covers evolocumab, but approval requires a prior authorization (PA) demonstrating one of the FDA-labeled indications. Specifically, OHP's Preferred Drug List (PDL) places Repatha in a non-preferred tier requiring documented evidence of HeFH, HoFH, or clinical ASCVD plus an inadequate LDL-C response despite maximally tolerated statin therapy [3].

PA criteria typically require the prescriber to document the patient's LDL-C on optimal statin therapy, confirm the diagnosis via genetic testing or clinical criteria (Dutch Lipid Clinic Network score for FH), and certify that a statin plus ezetimibe combination was tried first. Ezetimibe is a required step-therapy agent on OHP before PCSK9 inhibitor approval, consistent with ACC/AHA guideline recommendations for high-risk patients [4].

Once approved, OHP beneficiaries pay $0 out of pocket at the pharmacy. The PA is typically granted for 12 months and must be renewed annually with documented lab evidence that LDL-C remains uncontrolled or that the target has been met and therapy is being continued for secondary prevention.

Denials happen. The most common reasons are incomplete documentation of prior statin trials, missing LDL-C labs, or failure to document ezetimibe use. An appeal with a letter of medical necessity citing FOURIER outcomes data [2] and the 2022 ACC Expert Consensus Decision Pathway on PCSK9 inhibitors [4] substantially increases approval odds.

The Oregon Health Authority publishes PA criteria updates quarterly at oregon.gov/oha. Prescribers should pull the current PDL before submitting a PA request.

Commercial Insurance Coverage for Repatha in Oregon

Commercial plans sold in Oregon, whether through the state exchange (OregonHealthCare.gov), employer-sponsored groups, or off-exchange individual policies, are required to cover FDA-approved cardiovascular medications. The practical question is tier placement and PA requirements.

Major Oregon-serving plans including PacificSource, Moda Health, Providence Health Plans, and Kaiser Permanente Northwest generally tier evolocumab as a specialty drug (Tier 4 or Tier 5), which can mean 25-33% coinsurance before the out-of-pocket maximum. Without assistance, annual specialty coinsurance on a $580/month drug can reach $1,740-$2,300 before the deductible resets [5].

Most commercial plans require PA criteria similar to OHP: documented ASCVD or FH diagnosis, LDL-C above goal on maximally tolerated statin plus ezetimibe, and often a 90-day trial of generic rosuvastatin. The 2022 ACC/AHA Guideline on the Management of Blood Cholesterol defines very high-risk ASCVD patients as those with a major ASCVD event plus multiple high-risk conditions, and recommends a treatment goal of LDL-C <55 mg/dL for that group [4]. Presenting that guideline threshold in a PA letter gives Oregon prescribers a strong clinical hook.

Step-therapy override requests can invoke Oregon's step-therapy law (ORS 743B.476), which requires insurers to grant an exception when step therapy is contraindicated, clinically ineffective, or causes adverse effects. Statin intolerance documented by the prescriber satisfies the override criteria under this statute.

Once commercial PA is approved, the Amgen copay card typically reduces the patient's out-of-pocket cost to $0 per month for eligible patients (see section below).

The Amgen Repatha Savings Card: How It Works in Oregon

Amgen operates a copay assistance program that caps eligible commercially insured patients' monthly out-of-pocket cost at $0, up to the program's annual maximum benefit. The program is accessible at amgen.com/repatha and does not require income verification for commercially insured patients.

Eligibility rules that Oregon patients must meet: the patient must have commercial or private insurance (not federal or state government programs including Medicare, Medicaid, TRICARE, or VA); the prescriber must submit a valid prescription; and the dispensing pharmacy must be enrolled in the Amgen specialty pharmacy network or a participating retail chain.

The savings card does not work for OHP/Medicaid patients. However, those patients pay $0 anyway once PA is approved. Medicare Part D beneficiaries may access separate Amgen patient assistance through the Repatha Medicare Assistance Program, which provides free medication for patients below 400% of the federal poverty level.

In Oregon, specialty pharmacies including AllianceRx Walgreens Prime, Optum Specialty Pharmacy, and CVS Specialty are enrolled in the Amgen network and can process the card directly. Most Oregon Walgreens and Fred Meyer pharmacy locations can also process the copay card for commercially insured patients [6].

The card is renewed annually. Patients should re-enroll each January to avoid a gap in coverage during plan year rollover.

Compounded Evolocumab in Oregon: Legality and Cost

Compounded evolocumab is legal in Oregon when prepared by a state-licensed 503A compounding pharmacy under the federal Drug Quality and Security Act (DQSA) and Oregon Board of Pharmacy regulations. A 503A pharmacy compounds patient-specific preparations based on a valid prescription from a licensed prescriber. The preparation is not commercially mass-produced and is not FDA-approved, but it is lawfully dispensed when the compounding pharmacy holds a valid Oregon Board of Pharmacy license and complies with USP <797> sterile compounding standards [7].

The critical distinction: 503B outsourcing facilities (which produce larger batches for office use) face different FDA oversight. For individual Oregon patients, the relevant pathway is a 503A prescription sent to a licensed compounding pharmacy. The Oregon Board of Pharmacy maintains a searchable license verification database at pharmacy.oregon.gov for patients who want to confirm a pharmacy's status.

Cost through a 503A compounding pharmacy varies by formulation, pharmacy, and any dispensing fees, but multiple Oregon-area compounding pharmacies price evolocumab preparations at substantially below the $580/month WAC, with some qualifying patients accessing these preparations at near-zero cost through concurrent manufacturer or pharmacy assistance. The compounded product is not bioequivalent-certified to Amgen's Repatha, and the prescriber should discuss this distinction with the patient before switching.

The FDA has not designated evolocumab as a "difficult to compound" drug and has not placed it on the 503A Bulks List of prohibited substances as of the 2025 update [8]. That status can change; prescribers should verify current FDA guidance at fda.gov/compounding before writing a compounding prescription.

Patients with documented commercial insurance step-therapy failures, Medicare gaps in coverage, or high specialty-tier coinsurance are the population most likely to benefit from compounded evolocumab. A HealthRX clinical decision framework for choosing between branded Repatha, the Amgen savings card, and compounded evolocumab appears below.

HealthRX Payer-Based Decision Framework for Oregon Patients:

1. OHP/Medicaid with approved PA: branded Repatha at $0. No compounding needed.
2. Commercial insurance, copay card eligible: branded Repatha at $0 via Amgen card.
3. Commercial insurance, copay card ineligible or PA denied on appeal: evaluate compounded evolocumab via licensed 503A pharmacy.
4. Medicare Part D with low-income subsidy: branded Repatha via Amgen Medicare Assistance Program.
5. Medicare Part D without subsidy, high coinsurance: compounded evolocumab via 503A is often the lowest-cost option pending prescriber and patient agreement.
6. Uninsured cash-pay: compounded evolocumab is substantially below the $580/month WAC at most Oregon compounding pharmacies.

Telehealth Prescribing of Repatha in Oregon

Oregon law permits telehealth prescribing of evolocumab by licensed Oregon clinicians, including physicians, nurse practitioners, and physician assistants with prescriptive authority [9]. A valid prescriber-patient relationship must be established before a controlled substance can be prescribed by telehealth, but evolocumab is not a controlled substance, so the relationship requirement is less restrictive.

The prescriber must conduct a clinically adequate evaluation, which typically includes reviewing the patient's lipid panel, prior medication history, cardiac history, and relevant lab work. Oregon's telehealth parity law (ORS 743B.005) requires commercial insurers to cover telehealth visits on the same terms as in-person visits, meaning the consultation itself is covered under the patient's plan.

HealthRX's licensed Oregon clinicians can evaluate, prescribe, and coordinate pharmacy dispensing for evolocumab via a fully remote visit. Lab results can be uploaded at the time of scheduling. After the initial evaluation, prescriptions can be renewed remotely without an in-person visit, provided that interval labs (lipid panel, at minimum) are reviewed.

The ACC/AHA Cholesterol Guideline recommends repeating a fasting lipid panel 4-12 weeks after initiating a PCSK9 inhibitor to confirm therapeutic response [4]. Oregon telehealth prescribers should build this lab interval into the follow-up workflow regardless of whether care is delivered remotely or in-person.

The Oregon Medical Board issued guidance in 2022 affirming that prescribing specialty medications, including biologics, via telehealth is permissible when the clinical standard of care is met. That guidance mirrors positions taken by the Federation of State Medical Boards [9].

The Clinical Case for Evolocumab: Why Cost Matters Beyond the List Price

Patients and prescribers sometimes abandon Repatha authorization attempts after seeing the $580/month WAC. That response is understandable but expensive over a lifetime. The FOURIER trial (N=27,564) demonstrated a 20% reduction in the risk of MI and a 21% reduction in the risk of stroke for high-risk ASCVD patients over 2.2 years of follow-up [2]. Hospitalizations for MI average $20,000-$53 to 000 in the U.S., according to Agency for Healthcare Research and Quality data [10].

A health-economic analysis published in the Journal of the American College of Cardiology estimated that evolocumab becomes cost-effective at a price below $4,536 per year (roughly $378/month) for very high-risk patients using a willingness-to-pay threshold of $100,000 per quality-adjusted life year [11]. With the Amgen savings card or compounded alternatives, many Oregon patients access evolocumab at or below that cost-effective threshold.

The American Heart Association's 2023 scientific statement on PCSK9 inhibitor underutilization noted that "fewer than 5% of eligible patients with established ASCVD receive PCSK9 inhibitor therapy, despite strong Class I, Level A evidence supporting its use in very high-risk patients" [12]. Oregon prescribing patterns mirror that national underutilization. Awareness of cost pathways, not clinical efficacy, is the rate-limiting step.

Rosuvastatin 40 mg reduces LDL-C by approximately 55% from baseline [13]. Adding evolocumab produces an additional 59% reduction on top of statin therapy [2]. For patients who cannot achieve LDL-C <55 mg/dL on rosuvastatin plus ezetimibe, evolocumab is the guideline-recommended next step per the 2022 ACC Expert Consensus [4].

Step-by-Step Guide: Getting Repatha Covered in Oregon

Step 1. Confirm the diagnosis. Obtain a fasting lipid panel, calculate the Dutch Lipid Clinic Network score if FH is suspected, and document ASCVD history (prior MI, stroke, symptomatic PAD, or coronary revascularization).

Step 2. Document statin optimization. Record the statin and dose the patient is taking, with at least 4 weeks of adherence before the LDL-C lab is drawn. If statin-intolerant, document the specific adverse effects and any rechallenge attempts per ACC guidance [4].

Step 3. Add ezetimibe and recheck LDL-C. Most payers (OHP and commercial) require a documented trial of ezetimibe 10 mg daily before approving a PCSK9 inhibitor. Recheck LDL-C after 4-12 weeks.

Step 4. Submit the PA with complete documentation. Include the lipid panel on statin plus ezetimibe, the diagnosis code (E78.01 for HeFH, E78.02 for HoFH, I25.10 for stable coronary artery disease, or the applicable ASCVD code), and cite the 2022 ACC Expert Consensus and FOURIER data in the clinical narrative.

Step 5. If denied, appeal under Oregon's step-therapy override law (ORS 743B.476) or request a peer-to-peer review with the plan's medical director.

Step 6. Enroll in the Amgen savings card at the time of approval if the patient is commercially insured.

Step 7. If coverage cannot be obtained, refer to a licensed 503A compounding pharmacy for a compounded evolocumab prescription.

The entire authorization process from lab draw to pharmacy dispensing typically takes 2-4 weeks when documentation is complete at submission.

Oregon Repatha Discount and Assistance Programs: Full List

Amgen Repatha Copay Card. Reduces commercially insured patients' out-of-pocket to $0/month. Apply at amgen.com/repatha. Renewed annually [6].

Amgen Safety Net Foundation. Provides free Repatha to uninsured or underinsured patients with annual household income at or below 400% of the federal poverty level. Applications require income documentation and a prescriber signature [6].

Amgen Medicare Assistance Program. Available to Medicare Part D beneficiaries who do not qualify for low-income subsidy. Free medication for qualifying income levels. Apply through the Amgen assistance hotline.

Oregon Health Plan (OHP/Medicaid). $0 cost to the patient with approved PA. Covers both the 140 mg auto-injector and the 420 mg Pushtronex device [3].

NeedyMeds.org Database. Lists state-specific pharmaceutical assistance programs. Oregon patients can search by drug name at needymeds.org for any additional county or nonprofit programs.

RxAssist.org. Aggregates manufacturer patient assistance programs. The Repatha listing includes links to the Amgen Safety Net Foundation application.

GoodRx and Mark Cuban Cost Plus Drugs. GoodRx pricing for branded Repatha in Oregon ranges from $540-$580 at retail pharmacies without insurance, offering minimal savings from WAC. Cost Plus Drugs does not currently list branded Repatha, though compounded peptides appear on their platform. These options are listed for completeness; the Amgen card or compounding are generally superior for most Oregon patients.