Does Medicare cover PCSK9 inhibitors like Repatha and Praluent?

Question

Jeremy Harkins · Accepted Answer

Yes. Medicare can cover PCSK9 inhibitors such as Repatha and Praluent, but coverage depends on your specific Medicare drug plan.

Because Repatha and Praluent are medications you typically inject yourself, they are generally covered through Medicare Part D, rather than Part B. Medicare Part B mainly covers a limited group of medications that are given in a doctor's office or other outpatient medical setting. (medicare.gov)

The important part is that every Part D plan has its own formulary, or list of covered drugs. One plan may cover Repatha, another may prefer Praluent, and some plans may place additional requirements on coverage.

These medications may require prior authorization, step therapy, or documentation from your doctor showing why the medication is medically necessary. Medicare drug plans are allowed to use these coverage rules. (medicare.gov)

If your doctor prescribes Repatha or Praluent, check your exact Part D or Medicare Advantage drug formulary before assuming it is covered. If the prescribed medication is not covered, ask whether the plan prefers another PCSK9 inhibitor or whether your doctor can request a formulary exception.

So the short answer is yes, Medicare drug coverage may cover Repatha or Praluent, but you need to check the exact plan because coverage and approval requirements can vary.

Cody Biggs · Answer

Yes, Medicare can cover PCSK9 inhibitors such as Repatha and Praluent, but coverage depends on your specific Medicare Part D or Medicare Advantage prescription drug plan.

These medications are usually covered under Part D, and the insurance company may require prior authorization or other criteria before approving them. Coverage and out-of-pocket costs can vary considerably from one plan to another.

If you’re already taking Repatha or Praluent, or your doctor is considering prescribing one, I would recommend checking your specific plan’s formulary and coverage requirements before assuming it’s covered.

This is also why it’s so important to include all of your medications when comparing Medicare plans each year. The plan with the lowest monthly premium isn’t necessarily the plan that will cost you the least overall.

Corey Bennett · Answer

Yes, Medicare does cover PCSK9 inhibitors like Repatha and Praluent, but only under Part D or a Medicare Advantage plan with drug coverage, and the plan has to list them on its formulary. Most plans require prior authorization, and your copay can vary a lot depending on the plan.

Answered by Corey Bennett on August 26, 2026

Broker Licensed in IN

Answered by Corey Bennett Medicare Insurance Agent

Mark Bilgere · Answer

Yes PCSK9 inhibitors can be covered by Medicare. However, they will be covered under the Part D portion of your Medicare as they are self-administered. Your actual coverage and cost will depend specifically on your plan's formulary. These drugs typically require prior authorization.

Answered by Mark Bilgere on August 26, 2026

Broker Licensed in TX, AR, IN & LA, MN, NE & OK

Answered by Mark Bilgere Medicare Insurance Agent

Kenneth Parsons · Answer

Yes Medicare covers these are covered by part D under specialty drugs typically.  May require step therapy and prior authorization to get these.  For 2026 the Max out of pocket for drugs is 2100.

Michelle Hylton · Answer

An independent check confirms Repatha is widely covered by Alabama Medicare Advantage and Prescription Drug Plans (PDPs). In contrast, only one standalone PDP in the state covers Praluent, demonstrating how coverage heavily depends on each insurance company's specific formulary (drug list).

Answered by Michelle Hylton on August 21, 2026

Broker Licensed in AL, CA, FL & 5 other states

Answered by Michelle Hylton Medicare Insurance Agent

Marcia West · Answer

Most Medicare prescription drug plans and Medicare Advantage plans with Prescription Drug coverage will cover these drugs, although you will want to check the plan you are considering to make sure this or any treatment you receive is covered and what will be your out-of-pocket costs.

Answered by Marcia West on August 18, 2026

Agent Licensed in WA, FL, GA, MI, TX & VA

Answered by Marcia West Medicare Insurance Agent

Does Medicare cover PCSK9 inhibitors like Repatha and Praluent?

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Does Medicare cover PCSK9 inhibitors like Repatha and Praluent?

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