Does Medicare Cover Repatha? Part D Coverage and 2026 Costs
Yes, Medicare covers Repatha (evolocumab), but it is covered under Medicare Part D (prescription drug coverage), not Part B. Because Repatha is an injectable that you give yourself at home, Medicare treats it as a "usually self-administered" drug, which Part B does not pay for. To get coverage you need a standalone Part D plan or a Medicare Advantage plan that includes drug coverage (MA-PD). Most plans cover Repatha but apply rules like prior authorization or step therapy, and your cost depends on your specific plan's formulary.
Is Repatha covered under Part B or Part D?
Repatha is covered under Medicare Part D, the part of Medicare that pays for prescription drugs. It is not covered under Part B.
This trips up a lot of people, because Repatha is an injection, and many injectable drugs are covered by Part B. The difference is who gives the injection. Part B generally covers only drugs that are administered as part of a doctor's service and are NOT usually self-administered. Repatha comes in a pre-filled pen or syringe that you inject yourself at home, usually once or twice a month, so Medicare classifies it as a 'usually self-administered' drug.
Self-administered drugs are excluded from Part B except for a short list set by law (such as certain clotting factors, immunosuppressive drugs after a transplant, dialysis drugs, and a few oral cancer drugs). PCSK9 inhibitors like Repatha are not on that list, so they fall to Part D.
To actually get Repatha coverage, you need either a standalone Part D plan (a PDP, which you can add alongside Original Medicare) or a Medicare Advantage plan that includes drug coverage (an MA-PD). If you only have Original Medicare with no drug plan, Repatha is not covered.
What if my doctor injects Repatha in the office?
Getting a single dose at the doctor's office does not turn Repatha into a Part B drug. Medicare decides whether a drug is Part B or Part D based on whether it is 'usually self-administered' across patients in general, not on where one particular dose happens to be given. CMS defines 'usually self-administered' as self-administered by more than 50% of Medicare beneficiaries who use the drug.
Because Repatha is normally something patients inject themselves, it stays under Part D in nearly all cases, even when a dose is administered in a clinical setting. If you are told otherwise, ask your plan to confirm in writing before you assume Part B will pay.
How much does Repatha cost with Medicare in 2026?
Your exact cost depends on your specific Part D or MA-PD plan, the tier it places Repatha on, and where you are in the year. But two 2026 numbers shape what you'll pay overall.
- Out-of-pocket cap: In 2026, your total out-of-pocket spending on covered Part D drugs is capped at $2,100 for the year. Once you reach $2,100, you pay $0 for your covered Part D drugs, including Repatha, for the rest of the calendar year. For a high-cost drug, this cap is the most important protection.
- Plan premium: Part D plans charge a monthly premium that varies by plan. For reference, the national base beneficiary premium for 2026 is $38.99 per month. Your plan's premium and Repatha cost-sharing are on top of that.
- Higher-income surcharge (IRMAA): If your 2024 income was above $109,000 (single) or $218,000 (joint), you pay a Part D income-related surcharge of $14.50 to $91.00 per month in addition to your plan premium.
Prior authorization, step therapy, and formularies
Even when a plan covers Repatha, it can apply 'utilization management' rules before it will pay. These are allowed under Part D and vary from plan to plan, so check your plan's formulary.
If your plan doesn't cover Repatha or denies it, you have the right to ask for an exception (asking the plan to cover it or waive a rule) and to appeal a denial. Your doctor's supporting statement carries a lot of weight in these requests. During Medicare Open Enrollment (Oct 15 to Dec 7), you can also switch to a plan whose formulary covers Repatha on better terms.
- Prior authorization: Your plan may require your doctor to submit paperwork showing Repatha is medically necessary before coverage kicks in.
- Step therapy: Many plans require you to try lower-cost options first, such as statins and ezetimibe, and show they didn't work or weren't tolerated, before they'll cover Repatha.
- Quantity limits: Plans may limit how much they'll cover in a given period.
- Formulary differences: Some plans place Repatha on a high cost-sharing tier, and a few may not list it at all. To check, look up the specific plan's formulary on the plan's website or use the Plan Finder at Medicare.gov, and search for evolocumab (the generic name) as well as Repatha.
How to lower your Repatha costs on Medicare
Because Repatha is expensive, it's worth knowing which help is and isn't available to people on Medicare.
- The manufacturer copay card will NOT work. Amgen's Repatha Co-Pay Card cannot be used if any part of your prescription is paid by Medicare. Federal rules bar manufacturer copay cards for people with Medicare, so don't count on it.
- Extra Help (Low-Income Subsidy): If you have limited income and resources, the Part D Extra Help program sharply reduces your drug costs. In 2026, people with the full subsidy pay no more than $5.10 for a covered generic and $12.65 for a covered brand-name drug per prescription, which would apply to a covered Repatha fill; those who also have Medicaid (QMB) may pay even less.
- Choose the right plan: At Open Enrollment, compare plans on how they cover Repatha specifically, not just on premium. A plan with a higher premium but better Repatha cost-sharing can cost you less overall.
- Reach the cap: Once your out-of-pocket spending hits the $2,100 cap in 2026, you pay nothing more for covered Part D drugs the rest of the year.
Enrolling and avoiding a coverage gap
If you take Repatha or expect to need it, make sure you have Part D coverage in place. Delaying Part D when you don't have other creditable drug coverage can cost you for life.
The Part D late-enrollment penalty is 1% of the national base beneficiary premium ($38.99 in 2026) times the number of full months you went without creditable drug coverage, rounded to the nearest $0.10, and it's added to your premium for as long as you have Part D. So if you skip a drug plan and later need Repatha, you may pay extra every month going forward.
On whether Medicare covers Repatha for prevention versus after a heart attack or stroke: that is a clinical and plan-coverage question, not a Part B versus Part D question. Repatha is still a Part D drug either way, but your plan's prior authorization criteria may consider your diagnosis and history. Talk to your doctor and check your plan's coverage rules for your situation.
Frequently asked questions
Does Medicare Part B cover Repatha since it's an injection?
No. Even though Repatha is injectable, you give it to yourself at home, so Medicare treats it as a 'usually self-administered' drug. Part B does not cover those, except for a short statutory list that does not include PCSK9 inhibitors like Repatha. It's covered under Part D instead.
Do Medicare Advantage plans cover Repatha?
Most Medicare Advantage plans that include drug coverage (MA-PDs) cover Repatha, but it depends on the plan's formulary, and many apply prior authorization or step therapy. Check the specific plan's drug list, and search for both Repatha and its generic name, evolocumab.
Can I use the Repatha copay card with Medicare?
No. Amgen's Repatha Co-Pay Card cannot be used if any part of your prescription is paid by Medicare. Instead, rely on your Part D coverage, the Extra Help/Low-Income Subsidy if you qualify, and choosing a plan with good Repatha cost-sharing.
Is there a limit on what I'll pay for Repatha under Part D?
Yes. In 2026, your total out-of-pocket spending on covered Part D drugs is capped at $2,100 per year. Once you reach that cap, you pay $0 for your covered Part D drugs, including Repatha, for the rest of the calendar year.
Will I have to try statins before Medicare covers Repatha?
Possibly. Many Part D plans use step therapy, meaning you may need to try and fail lower-cost options like statins and ezetimibe first. The exact rule varies by plan, so check your plan's formulary and ask your doctor about requesting an exception if needed.
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