Does Medicare Cover Repatha?
Usually — Part D covers Repatha when statins alone aren’t enough, with criteria.
Drug Coverage · Heart & Blood
Repatha (evolocumab) is used for high cholesterol / cardiovascular risk (a PCSK9 inhibitor).
Does Medicare cover Repatha?
Usually — Part D covers Repatha when statins alone aren’t enough, with criteria. Covered for high cholesterol or cardiovascular risk, typically after statins haven’t worked or aren’t tolerated. Plans apply clinical criteria.
Which part of Medicare covers it?
Part D. These are self-administered prescriptions, so they fall under your Part D drug plan (or the drug coverage built into a Medicare Advantage plan), not Part B.
Typical formulary tier
Brand or specialty tier — varies by plan. Your exact tier — and copay — depend on the plan you choose, which is why matching the formulary to your medications matters.
| Drug | Used for | Covered by Medicare? | Typical formulary tier |
|---|---|---|---|
| Eliquis (apixaban) | blood clots and stroke prevention in AFib | Yes | Preferred brand (often Tier 3) |
| Xarelto (rivaroxaban) | blood clots and stroke prevention | Yes | Brand tier (often Tier 3) |
| Entresto (sacubitril/valsartan) | chronic heart failure | Yes | Brand tier (often Tier 3) |
| Repatha (evolocumab) | high cholesterol / cardiovascular risk (a PCSK9 inhibitor) | Yes, with conditions | Brand or specialty tier — varies by plan |
Prior authorization & plan rules
Prior authorization is common — plans usually require documented statin use or intolerance (step therapy) first.
If it isn’t covered (or costs too much)
If denied, your doctor can appeal with clinical documentation; manufacturer and foundation assistance can help with cost.
- Help paying for Repatha — assistance programs and grants.
- Compare Part D plans that cover Repatha on a better tier.
- How drug tiers work · Extra Help for lower-income beneficiaries.
Related medications
- Does Medicare cover Entresto? — sacubitril/valsartan
Related Medicare guides
- All drug coverage · Part D plans · how drug tiers work.
- Medicare costs · Glossary · Medicare Help Center.
Get a Real Answer for Your Plan — Free
Coverage and cost depend on your specific plan and diagnosis. Call us free at 435-219-5120 (TTY: 711) with your medication list, and we’ll tell you exactly what Repatha costs on your plan — and whether a different plan would cover it better. No cost, no pressure.
Frequently Asked Questions
Does Medicare cover Repatha?
Which part of Medicare covers Repatha?
What if my plan doesn’t cover Repatha?
Sources
- Medicare.gov — drug coverage (Part D) — Medicare.gov
Talk to a local, licensed agent
Rocco DeLuca can walk you through your options — free, no pressure.