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

Repatha, like most name brand medications, is typically a brand or tier three on many of the Medicare Part D formularies, as well as the formularies that we see with prescription drug coverage on the Medicare Advantage plans.

Now for the brand coverage, I will say that for most of these plans you will have to hit your deductible for this type of medication. And it depends on the plan. For some, Repatha can be less expensive on some plans over others. But most of the time, with a medication like this, and including if you have other name brand medications, you are more likely to hit your max out of pocket for prescription drugs, which is $2,100 for this year.

A lot of times what people will do is, if there are prescriptions like Repatha or any others out there that are more expensive, they can work with their doctor to hopefully change to a more affordable medication.

Ellen Diehl · Answer

A couple of questions to get started. Do you already have a Medicare supplement/Medigap plan G? Are you currently on a Part D plan? If you would like to reach out to me directly, contact me. And I can guide you. 
The most immediate way for you to get your answer would be to go out to Medicare.gov and shop for plans. Select part D. And it will begin to walk you through the process of entering in drugs, and it will let you know what companies cover that drug. I will tell you that Repath is very expensive, and it’s possible it might not be on any of the plans.

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.

Elea Sherrod · Answer

Repatha appears to be a brand name medication and may be in a higher tier. Each carrier has it's own formulary and it is best to search your specific carrier to see if the medication Repatha is covered and what the tier would be.

Answered by Elea Sherrod on June 15, 2026

Broker Licensed in CA, AL, AR & 35 other states

Answered by Elea Sherrod Medicare Insurance Agent

Arthur Kempton, III, USAF Retired · Answer

It depends on the Medicare D plan and formulary.  Based on my experience, the Repatha Injectable is a Tier 3 Brand medication.  Some Part D formularies list Repatha Injectable as a Tier 4.

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).