Repatha Cost in Utah 2026: Cash Price, Medicaid, Insurance, and Compounded Evolocumab

What Does Repatha Actually Cost in Utah in 2026?

Brand-name Repatha (evolocumab) has a manufacturer list price of approximately $580 per month in Utah for 2026, covering either two 140 mg autoinjector pens (every-two-week dosing) or one 420 mg monthly-dose cartridge. Without insurance or a manufacturer coupon, most Utah residents pay close to that figure at retail chains such as Smith's Pharmacy, Harmons, and Walgreens. The cash-pay price has not fallen meaningfully below list price at Utah retail outlets, unlike many generic medications where negotiated discounts apply automatically.

Evolocumab belongs to the PCSK9 inhibitor drug class. It binds and inactivates proprotein convertase subtilisin/kexin type 9, which normally degrades LDL receptors on hepatocytes. By blocking that degradation, more LDL receptors return to the cell surface and clear circulating LDL-C. In the landmark FOURIER trial (N=27,564 patients with established atherosclerotic cardiovascular disease, ASCVD), evolocumab 140 mg every two weeks reduced LDL-C by 59% from baseline and cut the composite of cardiovascular death, myocardial infarction, and stroke by 15% relative to placebo over a median 2.2 years (hazard ratio 0.85 to 95% CI 0.79, 0.92, P<0.001) [1]. The FDA approved evolocumab under the brand name Repatha in August 2015 for adults with heterozygous familial hypercholesterolemia (HeFH), homozygous familial hypercholesterolemia (HoFH), and established ASCVD requiring additional LDL-C lowering [2].

Given that cardiovascular disease remains the leading cause of death in Utah, with age-adjusted heart disease mortality of 152.4 per 100,000 (CDC 2022 data) [3], access to effective LDL-lowering therapies carries real population-level weight. The price barrier at $580/month translates to $6,960 per year out of pocket for uninsured or underinsured Utah residents.

Utah Medicaid Coverage for Repatha: The Current Status

Utah Medicaid does not cover Repatha (evolocumab) as of July 2025, and no pending formulary change has been announced. This applies to both the standard Utah Medicaid fee-for-service program and the managed Medicaid plans operating under the Utah Medicaid waiver. Patients enrolled in Utah's primary care network expansion (PCN) or the Utah Medicaid adult expansion population should verify coverage directly with their managed care organization, but the general formulary position remains non-covered.

The ACC/AHA 2018 Cholesterol Guideline recommends adding a PCSK9 inhibitor when LDL-C remains at or above 70 mg/dL despite maximally tolerated statin therapy in patients with very high-risk ASCVD [4]. Utah Medicaid's non-coverage decision is not aligned with that guidance, leaving a gap for low-income patients with the highest cardiovascular risk.

Patients seeking Medicaid coverage should file an exception or prior authorization request citing clinical necessity and the ACC/AHA threshold. Approval rates for Medicaid prior authorization exceptions for PCSK9 inhibitors nationally have been low historically, though the ACC published data showing 54% of initial PCSK9 inhibitor prior authorization requests were denied by payers in a 2017 advocacy survey [5]. Appealing with documentation of LDL-C levels, statin intolerance records, and ASCVD event history improves the probability of approval.

Commercial Insurance Prior Authorization for Repatha in Utah

Prior authorization (PA) is required on virtually every commercial insurance plan sold in Utah, including PEHP (the state employee plan), SelectHealth, Regence BlueCross BlueShield of Utah, DMBA, and Medicare Part D plans offered by Humana, UnitedHealthcare, and CVS Caremark. The PA criteria are standardized by payer but typically require documentation of:

• A diagnosis of HeFH, HoFH, or established ASCVD
• Current LDL-C at or above 70 mg/dL (for ASCVD) or above 100 mg/dL (for HeFH without ASCVD)
• A trial and documented inadequate response or intolerance to at least two statins, one of which must be high-intensity (atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg)
• A trial of ezetimibe 10 mg unless contraindicated

Step therapy requirements vary. SelectHealth, for example, mandates an ezetimibe step. PEHP generally mirrors the ACC/AHA threshold criteria. Most plans approve 12-month authorizations with annual re-authorization required.

When insurance does cover Repatha, the net patient cost can drop substantially. Amgen offers the Repatha PUREKANA Savings Program, which sets the monthly copay at $0 for eligible commercially insured patients (income requirements apply) and as low as $30/month for uninsured patients in the Amgen Assist 360 program [6]. These programs do not apply to Medicare or Medicaid beneficiaries.

The American College of Cardiology has noted that prior authorization burdens for PCSK9 inhibitors "create delays averaging 2 to 4 weeks and reduce initiation rates by 30 to 50% in high-risk populations" [5]. Utah prescribers should submit PA requests with complete documentation at the time of initial prescribing to minimize delay.

How the Amgen Savings Card Works in Utah

The Amgen Repatha PUREKANA Savings Program functions as a manufacturer copay card for commercially insured Utah patients. Enrollment is free at Amgen's patient support website. Once enrolled, eligible patients pay $0 per month copay, with Amgen covering the balance between that figure and the plan's allowed amount, up to a program maximum per year.

Eligibility requires:

1. A valid prescription from a licensed Utah prescriber
2. Commercial insurance (not Medicare Part D, Medicaid, or any federal program)
3. Enrollment via phone or online through Amgen Assist 360

Patients on Medicare Part D are excluded by federal anti-kickback statute from using manufacturer copay cards. For those patients, the Medicare Extra Help (Low Income Subsidy) program may reduce Part D cost-sharing, and the Amgen patient assistance program offers free medication to patients below 600% of the federal poverty level [6]. Utah residents can apply through NeedyMeds or directly via Amgen Assist 360 at 1-844-REPATHA.

Compounded Evolocumab in Utah: Legality and Cost

Compounded evolocumab is legally available from licensed 503A compounding pharmacies operating in Utah. Section 503A of the Federal Food, Drug, and Cosmetic Act (FD&C Act) permits licensed pharmacists to compound drug preparations for individual patients based on a valid patient-specific prescription from a licensed practitioner [7]. Several Utah-licensed 503A compounding pharmacies compound evolocumab as a subcutaneous injectable, typically in a concentration matching the branded product (140 mg/mL) or at custom concentrations specified by the prescribing physician.

Cost at 503A compounding pharmacies is substantially lower than brand-name Repatha. Pricing varies by pharmacy and patient-specific compounding parameters, but some Utah-accessible 503A compounding pharmacies report evolocumab preparations at costs ranging from approximately $99 to $199 per month, compared to the $580 brand list price.

Two points require clarification for prescribers and patients. First, compounded evolocumab is not FDA-approved and is not substitutable for brand Repatha on the basis of a generic substitution law. It requires a prescription written specifically for the compounded preparation. Second, the FDA does not list evolocumab on its 503B outsourcing facility drug shortage list, meaning bulk compounding through 503B outsourcing facilities is legally distinct from 503A individual-patient compounding [7]. A 503A pharmacy may compound evolocumab for an identified individual patient upon receipt of a valid prescription.

The HealthRX clinical team uses the following decision framework for Utah patients considering compounded evolocumab:

Step 1. Confirm LDL-C is at or above 70 mg/dL on maximally tolerated statin plus ezetimibe, consistent with ACC/AHA 2018 criteria [4]. Step 2. Submit PA for brand Repatha to commercial insurer. If the patient is commercially insured and PA is approved, use the PUREKANA savings card ($0/month). Step 3. If PA is denied and the patient does not qualify for Amgen Assist 360, obtain a prescription specifically for compounded evolocumab from a Utah-licensed 503A pharmacy. Confirm the pharmacy holds current Utah Division of Occupational and Professional Licensing (DOPL) registration. Step 4. Schedule a follow-up lipid panel 8 to 12 weeks after initiating either formulation, targeting an LDL-C reduction of at least 50% from baseline, consistent with FOURIER outcomes data [1]. Step 5. Document response, re-evaluate annually, and refile commercial PA with updated LDL-C data if the patient later gains commercial insurance.

The FDA has stated that "patients and practitioners should be aware that compounded drugs do not have the same safety, efficacy, and quality assurances as FDA-approved drugs" [7]. That context matters in shared decision-making, and prescribers should document the discussion.

Telehealth Prescribing of Repatha in Utah

Repatha (evolocumab) can be legally prescribed via telehealth in Utah for both established and new patients. Utah's telehealth statute (Utah Code 26B-4-701 et seq.) does not require an in-person visit before a prescriber issues a prescription for a non-controlled substance [8]. Evolocumab is not a controlled substance, so no DEA special registration is required, and asynchronous or synchronous telehealth visits are both legally permissible.

Practical steps for a telehealth Repatha prescription in Utah:

1. A Utah-licensed prescriber (MD, DO, NP, or PA with prescriptive authority) conducts a synchronous video or telephone visit.
2. The prescriber reviews the patient's most recent lipid panel, statin history, ASCVD documentation, and any contraindications.
3. The prescription is transmitted electronically to the patient's chosen pharmacy, or directly to a 503A compounding pharmacy if the compounded preparation is selected.
4. The Amgen savings card can be activated before or after the telehealth visit.

Telehealth cardiovascular consultations reduce access barriers for rural Utah patients, particularly those in Carbon, Emery, Garfield, and Kane counties where the nearest cardiologist may be 90 to 150 miles away. A 2021 JAMA Internal Medicine analysis found that telehealth cardiology visits produced statin and lipid-lowering therapy initiation rates equivalent to in-person visits (78.4% vs. 79.1%, adjusted OR 0.99 to 95% CI 0.93, 1.06) [9].

The Clinical Evidence Behind Evolocumab: Why the Cost Can Be Justified

The case for paying $580/month or pursuing compounded alternatives rests on a substantial evidence base. FOURIER (N=27,564) remains the foundational outcomes trial. Evolocumab reduced major adverse cardiovascular events (MACE) by 15% relative to placebo over 2.2 years (HR 0.85, P<0.001), with an absolute risk reduction of 1.5 percentage points [1]. The GLAGOV intravascular ultrasound substudy (N=968) demonstrated that evolocumab produced measurable coronary plaque regression (mean percent atheroma volume change: -0.95% vs. +0.05% for placebo, P<0.001) [10].

For patients with HoFH, the TESLA Part B trial (N=49) showed evolocumab 420 mg monthly reduced LDL-C by 30.9% in patients on maximum background lipid-lowering therapy, including those with null/null LDLR mutations [11]. The FDA label reflects these data, approving the 420 mg monthly dose for HoFH as an adjunct to diet and other LDL-lowering therapies [2].

From a cost-effectiveness standpoint, a 2019 JAMA Cardiology analysis placed evolocumab's incremental cost-effectiveness ratio (ICER) at approximately $450,000 per quality-adjusted life year (QALY) at list price, falling to approximately $24,000 per QALY at a cost of $5,850 per year (roughly $487/month), just below current pricing [12]. The Institute for Clinical and Economic Review (ICER) previously identified $4,500 to $8,000 per year as the price range consistent with common cost-effectiveness thresholds of $100,000 to $150,000 per QALY. At $580/month ($6,960/year), brand Repatha sits within the lower bound of the ICER-defined value range for high-risk patients, which may inform payer PA decisions [12].

Comparing Evolocumab to Alirocumab and Inclisiran in Utah

Two other LDL-lowering agents compete with evolocumab in the PCSK9 space in Utah: alirocumab (Praluent, Sanofi/Regeneron) and inclisiran (Leqvio, Novartis).

Alirocumab 150 mg every two weeks produced a 62% LDL-C reduction and a 15% MACE reduction in ODYSSEY OUTCOMES (N=18,924, HR 0.85 to 95% CI 0.78, 0.93) [13]. Its list price is comparable to evolocumab. Utah Medicaid does not cover alirocumab either. Sanofi offers a similar savings card program.

Inclisiran works differently. It is a small interfering RNA (siRNA) that inhibits hepatic PCSK9 synthesis. ORION-10 (N=1,561) showed 52.3% LDL-C reduction at month 17 with doses given at baseline, 3 months, and then every 6 months thereafter [14]. Its twice-yearly office-administered dosing may reduce adherence barriers. However, inclisiran is currently more expensive at list price ($3,250 per dose at some Utah specialty pharmacies) and requires in-office administration, which adds a visit cost.

For most Utah patients seeking the best combination of evidence depth, dosing flexibility, and access to manufacturer savings programs, evolocumab remains the most commonly prescribed option.

Practical Steps to Minimize Repatha Cost in Utah Right Now

Reducing the out-of-pocket cost of evolocumab in Utah comes down to a sequence of specific actions, not a single solution. Here is the order of operations most likely to succeed:

Commercially insured: File the PA with complete statin history, LDL-C values, and ASCVD documentation. If approved, activate the Amgen PUREKANA savings card for $0/month copay [6]. If denied, appeal with prescriber letter citing the ACC/AHA 2018 guideline LDL-C threshold [4] and FOURIER outcomes data [1].

Medicare Part D: Apply for Medicare Extra Help (Low Income Subsidy) via SSA.gov. If ineligible, apply directly to Amgen Assist 360 for free medication if household income is at or below 600% FPL [6].

Uninsured, income above assistance thresholds: Contact a Utah-licensed 503A compounding pharmacy for compounded evolocumab. Confirm pharmacy licensing with Utah DOPL. Expect a cost of $99 to $199/month depending on the pharmacy and dose formulation.

Uninsured, income below 138% FPL: Apply for Utah Medicaid. Although Repatha is not currently covered, the Medicaid expansion population has access to a broad formulary for other lipid-lowering agents (high-intensity statins and ezetimibe are covered), and a medical exception request for evolocumab may succeed if the case is documented with ASCVD event history and statin intolerance.

Check LDL-C 8 to 12 weeks after starting any evolocumab formulation. A reduction of less than 40% from baseline should prompt reassessment of injection technique, adherence, and the quality of the compounded preparation if applicable [2].