What tier is Repatha on Medicare Part D formularies?

Question

Jonathan Potter · Accepted Answer

Not every company will have it at a 3 but I checked three local companies and they all had it at a tier 3.

Michael Andrews · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/what-tier-is-repatha-on-medicare-part-d-formularies#michael-andrews

Jason Denniston · Answer

Most Medicare Part D plans do cover Repatha, but it’s commonly listed on one of the higher formulary tiers rather than a generic or preferred brand tier. In real life, that usually means you may pay a percentage of the drug cost instead of a flat copay.

The tricky part is that every plan handles it a little differently, so it’s worth  working with a broker who can compare various plans’ formularies before enrolling.

Terry Salak · Answer

Repatha can be tiered differently on and Part D drug plan, including both MAPD and PDP plans. That is why it's important to discuss these plan details with a licensed Medicare agent in your area. The services for a licensed agent do not cost you anything but you will be given a lot of useful knowledge and hopefully gain a trusted advisor to work with for years to come.

Answered by Terry Salak on May 5, 2026

Agent Licensed in FL, AL, AZ & 11 other states

Answered by Terry Salak Medicare Insurance Agent

Thomas Magnus, RHU · Answer

Each Medicare Rx plan(and there are MANY) uses a Formulary system to categorize drugs they cover. Drugs are listed based on cost, where administered(self or clinic), and various other factors. Your drug will fall into one of 5 or 6 Tier levels. Generic drugs are normally classified as Tier 1. The more expensive the drug, the higher the Tier Level. Repatha is listed at least at Tier Level 3.

Answered by Thomas Magnus, RHU on June 1, 2026

Broker Licensed in CA, AZ, NV, OR & WA

Answered by Thomas Magnus, RHU Medicare Insurance Agent

Melanie Rogers · Answer

Repatha may be on different tiers depending on the plan and carrier. I find it mostly on Tier 3 on the formularies. I have a few clients on Repatha so I will say that you should look into the cost carefully when comparing plans as it can differentiate by quite a bit depending on the cost of the Tier 3, the Part D drug deductible and if the Deductible applies to tier 3 or not.

Answered by Melanie Rogers on May 4, 2026

Agent Licensed in FL, GA, OH & TX

Answered by Melanie Rogers Medicare Insurance Agent

Daniel Fraser · Answer

This depends on your Part D carrier but typically Repatha is a Tier 3 Brand Name drug. Here in Florida, there are carriers that do not cover Repatha so as always, have your Agent/Broker shop your drug plan during the Annual Election Period (10/15 - 12/7).

Answered by Daniel Fraser on May 7, 2026

Broker Licensed in FL

Answered by Daniel Fraser Medicare Insurance Agent

Melissa Hatten · Answer

Here’s the honest answer:

There is no one set tier across all plans… but most of the time, Repatha sits on a higher or specialty tier.

And here’s why that matters.

Repatha is not a cheap, everyday medication. It’s a specialty drug used for serious cholesterol and heart risk issues. Because of that, Part D plans usually place it on:

Tier 3 (non-preferred brand) in some plans
Tier 4 or 5 (specialty tier) in many others

Just because it’s “covered”… does NOT mean it’s cheap.

Most plans do cover it—about 95% of them—but they almost always come with rules attached like:

Prior authorization (your doctor has to justify it)
Step therapy (you may have to try other meds first)

And here’s the part people don’t realize…

One plan might have Repatha sitting on a Tier 3 with a manageable copay…
Another plan might put it on a specialty tier where you’re paying a percentage—and that can feel expensive.

Even though many people end up around $50/month, that’s plan-specific, not guaranteed.

Jennifer Kalbach · Answer

Carriers decide what formularies they are going to cover and at what tier they are not the same from plan to plan and they can drop any formulary at any time.

Frances Eleanor Mitchell · Answer

Repatha is a tier 3 medication it does need prior authorization and there are quantity limits. The cost is going to be different depending on the Rx plan that you currently have

Laurie Baumgartner · Answer

Of course, there are a number of variables - it all depends on which Medicare prescription drug plan you have in place, and which pharmacy you use, whether it is in-network or a preferred pharmacy, and whether or not you have to pay a deductible first.

If you are on a low costing premium pharmacy plan( exmp. $5.30) -- the monthly medication could cost you a higher amount $ for the first month.  approximately $700.00, then $200.00 monthly after that....

or if you are on a Higher premium pharmacy plan --(exmp. $103.00) the monthly medication for the first month may cost you $282.00  and $92 monthly thereafter.

REGARDLESS, once you hit an out of the pocket max amount of $2100.00 (2026) - you will pay nothing after that.

the most that it will cost you out of pocket in a years time is $2100. (for all of your meds).