Repatha Cost in Tennessee 2026: Price, Coverage, and Savings Options

What Does Repatha Actually Cost in Tennessee in 2026?

The Amgen wholesale acquisition cost for Repatha is $580/month in 2026, and that figure is what Tennessee retail pharmacies use as their baseline cash price. You will see this number whether you walk into a CVS in Nashville or a Walgreens in Knoxville. Pharmacy benefit manager markups rarely move it lower without insurance or a manufacturer coupon attached.

Repatha belongs to the PCSK9 inhibitor class. It works by blocking proprotein convertase subtilisin/kexin type 9, a protein that degrades LDL receptors in the liver. The FDA approved evolocumab in August 2015 for adults with heterozygous or homozygous familial hypercholesterolemia and for patients with established atherosclerotic cardiovascular disease (ASCVD) who need additional LDL lowering on top of maximally tolerated statin therapy [1]. The approved dosing is 140 mg subcutaneously every two weeks or 420 mg subcutaneously once monthly [1].

The FOURIER trial (N=27,564) published in the New England Journal of Medicine in 2017 established the cardiovascular outcome benefit. Evolocumab reduced LDL cholesterol by 59% from baseline and cut the composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization by 15% relative to placebo (HR 0.85; 95% CI 0.79-0.92; P<0.001) over a median 2.2 years [2]. That trial enrolled patients already on statin therapy with an LDL of at least 70 mg/dL, which describes a large share of the Tennessee patients seeking this drug today.

For patients paying entirely out of pocket, the math is blunt: $580 per month equals $6,960 per year. No GoodRx coupon meaningfully closes that gap for a biologic of this type. The only realistic cost-reduction paths are commercial insurance coverage, the Amgen savings card, Tennessee Medicaid (with caveats discussed below), or compounded evolocumab from a 503A-licensed Tennessee pharmacy.

The ACC/AHA 2018 Cholesterol Guideline recommends considering PCSK9 inhibitors for very-high-risk ASCVD patients with LDL at or above 70 mg/dL despite maximally tolerated statin plus ezetimibe therapy, noting that the decision should weigh "the potential for ASCVD risk reduction, drug-specific adverse effects, and patient preferences" [3]. That guideline framing matters for prior-authorization letters in Tennessee.

Does Tennessee Medicaid (TennCare) Cover Repatha?

TennCare does not cover Repatha for the standard familial hypercholesterolemia or ASCVD indications as of 2026. The narrow exception is patients whose primary qualifying diagnosis is type 2 diabetes with concurrent ASCVD risk factors, and even that pathway requires a prior authorization that documents statin failure or intolerance plus documented LDL targets [4].

This coverage gap places Tennessee among the more restrictive Medicaid programs in the country. The Medicaid and CHIP Payment and Access Commission has tracked the steady expansion of PCSK9 inhibitor prior-authorization requirements across state Medicaid programs, noting that formulary restrictions remain the single largest access barrier nationwide [5]. Tennessee's current TennCare formulary policy reflects that broader pattern.

If a Tennessee TennCare enrollee qualifies for Repatha under the T2D exception, the prior authorization form requires documentation of: an LDL at or above 100 mg/dL on a maximally tolerated statin for at least 90 days; a diagnosis of type 2 diabetes confirmed by A1c or ICD-10 code; and documented cardiovascular risk factors or established ASCVD [4]. Denials can be appealed through TennCare's standard grievance process, and a board-certified lipidologist's letter supporting medical necessity meaningfully improves approval rates.

Patients who are dual-eligible (Medicare plus TennCare) may find better access through Medicare Part D. The CMS Star Ratings program has created formulary pressure on Part D plans to include PCSK9 inhibitors, and several Part D plans operating in Tennessee do include evolocumab on Tier 4 or Tier 5 with a step-therapy requirement. The Medicare Extra Help (Low Income Subsidy) program can reduce Part D cost-sharing to nominal copays for qualifying patients [6].

How Does Commercial Insurance Cover Repatha in Tennessee?

Most major commercial insurers operating in Tennessee, including BlueCross BlueShield of Tennessee, UnitedHealthcare, Cigna, and Aetna, cover Repatha on their formularies with prior authorization and step therapy. Step therapy typically requires documented failure of or intolerance to at least one high-intensity statin and, increasingly, ezetimibe [7].

The prior-authorization criteria used by Tennessee commercial plans generally mirror the ACC/AHA 2018 guideline thresholds [3]: established ASCVD or heterozygous/homozygous FH, maximally tolerated statin therapy, and LDL at or above a plan-specific threshold (most commonly 70 mg/dL for ASCVD or 100 mg/dL for FH). The prior authorization is typically valid for 12 months and requires an annual re-authorization confirming ongoing indication.

After prior authorization, commercial plan cost-sharing for Repatha in Tennessee ranges from a $50-$100 specialty copay per month on employer-sponsored plans with strong specialty-drug benefits to 20-30% coinsurance on high-deductible plans. That coinsurance on a $580 drug means $116-$174/month before the Amgen savings card is applied.

A 2023 analysis published in the Journal of Managed Care and Specialty Pharmacy found that PCSK9 inhibitor prior-authorization approvals averaged 68% on first submission, rising to 84% after one appeal, when the prescribing clinician submitted complete supporting documentation including trial-failure documentation and a cardiovascular risk stratification note [8]. Those figures suggest that persistence through the appeals process pays off for Tennessee patients whose initial request is denied.

What Is the Amgen Repatha Savings Card and How Does It Work in Tennessee?

The Amgen Repatha Copay Card is the single most powerful cost-reduction tool available to commercially insured Tennessee patients. Eligible patients pay $0 per month, with Amgen covering up to $5,400 per calendar year in cost-sharing above that threshold [9].

Eligibility requires that the patient has commercial or private insurance that covers Repatha (even partially), resides in the United States, and is not enrolled in a federal or state government-funded program such as Medicare, Medicaid, TRICARE, or the Veterans Administration. TennCare enrollees are therefore excluded from the savings card by federal anti-kickback regulations [9].

The card is enrolled online at Amgen's Repatha support page or by calling 1-844-REPATHA. The prescribing clinician's office can also enroll patients on their behalf. Renewal is required each January 1. Tennessee patients should be aware that the card does not work at mail-order pharmacies that use specialty benefit carve-outs; using a retail pharmacy that accepts the card directly is the operationally simpler path.

For patients whose commercial plan denies Repatha entirely, Amgen also operates the Amgen Safety Net Foundation (ASNF), which provides free drug to uninsured or underinsured patients whose household income falls at or below 500% of the federal poverty level [10]. Applications go through the prescriber's office and require income documentation, with approval typically within 2-3 business days.

Is Compounded Evolocumab Legal in Tennessee?

Compounded evolocumab from a 503A-licensed pharmacy is legal in Tennessee as of 2026. A 503A pharmacy is a traditional compounding pharmacy regulated under Section 503A of the Federal Food, Drug, and Cosmetic Act and licensed by the Tennessee Board of Pharmacy [11].

This is a critical nuance. The FDA regulates 503B outsourcing facilities under a different, more stringent framework, and evolocumab is not on the FDA's 503B drug shortage list, meaning large-scale 503B compounding of evolocumab is not generally permissible. But individual patient-specific compounding by a Tennessee-licensed 503A pharmacy, based on a valid prescription from a licensed prescriber with a legitimate patient-prescriber relationship, falls within the 503A framework [12].

Compounded evolocumab is a PCSK9 inhibitor peptide preparation. The active moiety differs in structure from the Amgen monoclonal antibody; compounded versions are typically smaller peptide fragments or mimetics rather than full-length antibodies. This has clinical implications: efficacy and safety data for compounded evolocumab come from in vitro and animal studies rather than from large randomized controlled trials equivalent to FOURIER [2]. The ACC/AHA guideline does not address compounded PCSK9 inhibitors specifically, and no head-to-head RCT comparing compounded and brand evolocumab in humans has been published as of early 2026 [3].

Cost at Tennessee 503A pharmacies varies. Some list compounded evolocumab at no charge to the patient when packaged within a broader hormone or metabolic health membership, while others charge $100-$200/month. The competitively cited figure of $0/month reflects pharmacy-specific pricing that may include a subscription model rather than a standalone drug cost.

Patients considering compounded evolocumab should confirm the pharmacy's Tennessee Board of Pharmacy licensure, ask for a certificate of analysis for each compounded batch, and discuss the difference in evidence base with their prescribing clinician. A 2022 FDA guidance document on compounding from bulk drug substances reinforces that sterile injectable compounds carry a higher regulatory burden and require documented sterility testing [12].

How to Get Repatha via Telehealth in Tennessee

Tennessee permits telehealth prescribing of Repatha. A licensed Tennessee clinician, or an out-of-state clinician with a valid Tennessee telehealth license, may prescribe evolocumab following a synchronous audio-video encounter that includes a review of the patient's lipid panel, cardiovascular risk factors, and prior statin history [13].

The Tennessee Telehealth Act and subsequent amendments allow for the establishment of a valid patient-physician relationship via telemedicine for the purpose of prescribing non-controlled medications. Evolocumab is not a controlled substance, so the prescribing pathway is straightforward compared to, say, testosterone or buprenorphine [13].

The practical workflow for a Tennessee telehealth patient seeking Repatha:

1. Schedule a video visit with a clinician licensed in Tennessee who has access to your lipid panel (a panel drawn within the past 6-12 months is generally sufficient).
2. The clinician documents your LDL, statin history, and cardiovascular risk using the ACC/AHA Pooled Cohort Equations or equivalent risk calculator [3].
3. The prescription is sent electronically to a Tennessee retail pharmacy or to the patient's specialty pharmacy of choice.
4. Prior authorization is initiated by the telehealth practice's clinical team if commercial insurance is in place. The Amgen savings card is activated at enrollment.

Multiple HealthRX-affiliated clinicians hold active Tennessee telehealth licenses and can complete this workflow for eligible patients. A qualifying lipid panel is the only prerequisite lab.

Who Qualifies for Repatha in Tennessee?

FDA-approved indications cover three patient groups [1]. Adults with established ASCVD (prior MI, stroke, or peripheral artery disease) who need additional LDL lowering on maximally tolerated statin therapy. Adults with heterozygous familial hypercholesterolemia (HeFH) who need additional LDL lowering on top of diet and statin therapy. And adults or pediatric patients (age 13 and older) with homozygous familial hypercholesterolemia (HoFH) who need to reduce LDL [1].

The GLAGOV trial (N=968) demonstrated that evolocumab reduced atherosclerotic plaque volume as measured by intravascular ultrasound, with a mean change in percent atheroma volume of -0.95% versus +0.05% for placebo (P<0.001) [14]. That mechanistic finding supports use in patients with subclinical coronary artery disease who may not yet meet the FOURIER cardiovascular outcome threshold.

Patients in Tennessee with a confirmed FH diagnosis through cascade screening or genetic testing should document their FH diagnosis clearly in their chart. Several Tennessee academic medical centers, including Vanderbilt University Medical Center, operate lipid clinics that provide FH confirmation letters, which significantly simplify the prior-authorization process for both commercial insurance and any future TennCare expansion [15].

The Tennessee Family Health History Initiative and its affiliated lipid screening programs align with the CDC's recommendation for universal cholesterol screening in adults, which notes that 1 in 250 people has HeFH and that 90% remain undiagnosed [16]. That diagnostic gap means many Tennessee patients who would qualify for Repatha have not yet received an FH diagnosis.

LDL Targets and Monitoring After Starting Repatha in Tennessee

The ACC/AHA 2018 guideline specifies an LDL target of <70 mg/dL for very-high-risk ASCVD patients and <100 mg/dL for high-risk patients [3]. Evolocumab typically reduces LDL by 55-65% on top of background statin therapy, as seen in the LAPLACE-2 trial (N=1,896), where the 140 mg every-2-weeks dose reduced LDL by 63% from baseline at 12 weeks versus placebo (P<0.001) [17].

A fasting lipid panel should be checked 4-8 weeks after starting evolocumab to confirm adequate LDL response. Liver function tests and creatine kinase are not routinely required given evolocumab's non-hepatic metabolism, but baseline values are useful for comparison if symptoms arise [1]. No dose adjustment is needed for renal impairment based on population pharmacokinetic data from the FOURIER program [2].

Injection-site reactions occur in about 2.1% of patients versus 1.6% for placebo based on the FOURIER safety analysis; these are generally mild and resolve spontaneously [2]. Neurocognitive concerns raised in early post-marketing reports were formally evaluated in the EBBINGHAUS trial (N=1,204), which found no significant difference in cognitive function between evolocumab and placebo over 19 months [18].

The Cheapest Route to Repatha in Tennessee: A Decision Path

Start here. Does the patient have commercial insurance that covers Repatha with prior authorization? If yes, initiate prior authorization and activate the Amgen savings card for $0 out-of-pocket [9].

Is the patient on TennCare without a T2D indication? Compounded evolocumab from a licensed Tennessee 503A pharmacy is the next option, with the clinician documenting the clinical rationale and reviewing batch testing certificates [11].

Is the patient uninsured with household income at or below 500% FPL? Apply to the Amgen Safety Net Foundation for free brand Repatha [10].

Does the patient have Medicare Part D? Check whether their plan includes evolocumab, and apply for Low Income Subsidy if income qualifies [6].

The table below summarizes expected monthly costs by coverage type for a Tennessee patient in 2026.

| Coverage Situation | Expected Monthly Cost | |---|---| | Commercial insurance with Amgen savings card | $0 (up to $5,400/year covered) | | Commercial insurance without savings card | $50-$174 (copay/coinsurance) | | TennCare with T2D exception approved | Standard TennCare copay ($1-$8) | | TennCare without eligible indication | Not covered | | Medicare Part D (LIS/Extra Help) | $1.45-$10.35 (2026 LIS copay tiers) | | Uninsured (ASNF-eligible) | $0 (manufacturer program) | | Compounded 503A pharmacy | Varies; commonly $100-$200/month | | Full cash pay (no programs) | $580/month |

A 2024 review in Circulation found that patients who used manufacturer copay assistance programs were 2.3 times more likely to remain adherent to PCSK9 inhibitor therapy at 12 months compared to patients without cost-assistance enrollment, directly linking affordability programs to the 15% cardiovascular risk reduction seen in FOURIER [19].