Cholesterol is a normal and healthy substance produced by the body, and lubricates the cardiovascular system to allow for blood flow and nutrient transference. There is a delicate balancing act involved in regulating cholesterol, and too much of one type and too little of the other can lead to problems. High-density and low-density lipoproteins, or HDL and LDL, are the two designations in cholesterol types used to determine whether the balance of cholesterol is healthy.
Too much LDL is considered a medical concern as it may indicate that someone is at risk for a heart attack or stroke due to reduced blood flow and high pressure in the body’s arteries. For many people, making changes to diet and adding exercise into a daily routine can counteract the development of heart problems due to LDL, but for others, the body naturally produces too much LDL and medications, including Repatha, are required to strike the right balance and protect the heart.
What is Repatha?
Repatha (evolocumab) is an injectable medication that works with the liver to remove LDL from the body. This is done by changing the way that a specific protein is processed and by using the liver’s natural mechanism of action to balance cholesterol levels. In many cases, Repatha can reduce LDL to healthy levels within a few weeks of use, but other patients may not see results for a few months. Common side effects of Repatha may include flu-like symptoms that go away in time, but for some individuals, there is a risk of an allergic reaction causing itching and hives.
Does Medicare Cover Repatha?
Repatha is covered by most Medicare benefits plans under Medicare Part D, the prescription drug benefit. The medication is self-injected and can usually be purchased from a retail pharmacy, meaning it falls within the guidelines for Medicare drug coverage. This will, however, depend on your plan’s formulary, or the list of medications covered by your plan. If Repatha is administered in a physician’s office or clinic, it may fall under the outpatient coverage of Medicare Part B, and if the drug is given during a stay in a hospital or skilled nursing facility, the coverage may fall under Medicare Part A.
Coverage cost for the drug varies based on plans. Some Medicare recipients will pay a lower price if they qualify for a low-income subsidy, while others will have coverage applied to the list price of the drug. Additionally, some Medicare recipients will fall in between and pay a reduced price that is lower than list price and higher than the subsidized price.