Monday, July 8, 2024

Is Repatha Covered By Medicare Part D

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Cigna Medicare Part D Overall Review

Medicare-Part-D-Explained (2023)

The biggest highlight of Cignas prescription drug plans is the pharmacy network. This carriers multiple plan options provide coverage for thousands of drugs. However, drug prices may not be as low as those through some other carriers.

However, convenience often warrants a higher cost. Still, if this carrier has the lowest annual out-of-pocket costs for you, it will be worth the enrollment.

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Is There Any Financial Support I Can Obtain To Help Me With My Out

If you have commercial or private insurance through your employer, your spouses employer, or through a private insurance carrier, you may be eligible for the Repatha® Copay Card. Eligible commercially insured adults may pay $5 per month** with the Repatha® Copay Card. You can enroll in theRepathaReady® program by visiting or by contacting 1-844-REPATHA .

For adults with Medicare or Medicaid, if youre enrolled in Medicare Extra Help or Low Income Subsidy , youll pay no more than $10 per month for Repatha®. For more information about Medicare Extra Help, or to enroll if youre eligible, you can visit or call 1-800-MEDICARE. If you dont have insurance,RepathaReady® can help you with other potential financial assistance options.

May Pay $5 Per Month Forrepatha*

With the Repatha® Copay Card, eligible patients can lower out-of-pocket costs and may pay $5 per month* up to program maximums.

To enroll and use the Copay Card, follow these 3 simple steps:

Sign up for the Copay Card by enrolling in theRepathaReady® program below

Print, Screenshot, or SaveCopay Card Info shown on Confirmation Page or Confirmation Email

your Copay information with your pharmacist when picking up your prescription and pay as little as $5 month* for Repatha®

Questions about the Copay Card? see the frequently asked questions or contact us at 1-844-REPATHA

Which best describes your insurance or coverage?

Which best describes your insurance or coverage?

1. Data on file, Amgen 2021. 2. Find your level of Extra Help . Medicare. . Accessed November 12, 2020.

Common Questions About the Copay Card and financial support

Common Questions About the Copay Card and financial support



It is important that every patient read and understand the full Repatha® Copay Card Terms and Conditions. The following summary is not a substitute for reviewing the Terms and Conditions in their entirety.

As further described below, in general:

Repatha® Copay Card Full Terms & Conditions

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Figure 2 Distribution Of Non

Moreover, regional differences in plan offerings might result in disparities of access and affordability across the US. As required under the Medicare Modernization Act, Part D plans operate around geographic regions established by CMS, with different premiums and coverage. Avalere analysis finds that more than 80% of Part D beneficiaries in areas of the Northeast US and California can access PCSK9 inhibitors only on non-preferred tiers in 2020, which could impact their OOP liability.

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Please call us at 1-844-REPATHA to complete your request.


Summary of Terms and Conditions

It is important that every patient read and understand the full Repatha® Copay Card Terms and Conditions. The following summary is not a substitute for reviewing the Terms and Conditions in their entirety.

As further described in the full terms and conditions, in general:

Repatha® Copay Card Full Terms & Conditions

Eligibility Criteria: Subject to program limitations and terms and conditions, the Repatha® Copay Card is open to patients who have a Repatha® prescription and who have commercial or private insurance, including plans available through state and federal healthcare exchanges. This program helps eligible patients cover out-of-pocket costs related to Repatha®, up to program limits. There is no income requirement to participate in this program.

  • The Repatha® Copay Card helps provide out-of-pocket support to eligible patients for their Repatha® prescription up to program limits. See PROGRAM DETAILS for full description.

    If at any time a patient begins receiving prescription drug coverage under any state or government program , the patient will no longer be able to use this card and they must contact RepathaReady® at1-844-REPATHA to stop their participation in this program.

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    What Happens With High Cholesterol

    Cholesterol is a fatty substance found in the cells of your body. Its made in your liver. Cholesterol can also be found in foods such as eggs, cheese, and meat.

    Cholesterol itself isnt a harmful substance. Your body uses cholesterol to make some vitamins, hormones, and fluids that help you digest food.

    High cholesterol occurs when you have more cholesterol in your blood than your body needs. This may be caused by genetics, smoking, not getting enough physical activity, or eating too many foods that are high in cholesterol. High cholesterol can raise your risk for heart disease.

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    Need Help With Repatha Access For Your Patients

    A virtual Repatha® Access Specialist who understands coverage in your region is available when you need assistance.

    Contact your Virtual RAS for questions about access topics such as:

    • Understanding a payers coverage eligibility criteria
    • Navigating the PA process and/or appeals
    • Finding the correct form to use

    For Virtual RAS support,

    Access Repatha® coverage information, prior authorization requirements, health plan PA forms, and more.

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    What Are The Total Costs For The Plan And My Drugs

    Several factors can affect the total cost for a Part D plan during the year, including premiums, deductible and copayments for your medications. Plans are allowed to charge a deductible of up to $480 in 2022, but some have no deductible.

    Premiums can vary significantly, but a plan with low premiums may cost you more if it has high copayments for your drugs. When youre in the Plan Finder, you can sort the plans by Lowest drug + premium cost to find out which plans total costs will be least expensive for you for the year.

    The Plan Finder also shows your estimated total monthly drug costs for each plan. That can be helpful if youre looking for a plan that spreads expenses throughout the year rather than charging the biggest bills in the first few months.

    Part D has no coverage caps, but after you spend $7,050 out of your pocket in 2022, you reach Medicares catastrophic coverage level. After that, you pay 5 percent or less of your drugs retail costs.

    How Long Does It Take To Work

    Medicare Part D Explained (2022)

    Repatha begins working as soon as you inject your dose. It takes about 4 hours after you take your dose for Repatha to start blocking the PCSK9 enzyme to its full ability.

    However, youre unlikely to notice the drug working in your body. This is because you cant feel your cholesterol increasing or decreasing. Blood test results are the only way to tell if the drug is working.

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    How Does The Donut Hole Work In Medicare

    The donut hole in Medicare is a coverage gap that occurs when you and your drug plan reach a certain spending threshold. To get out of the donut hole, your out-of-pocket costs must exceed a specific dollar amount. Costs that can be applied toward closing the donut hole include deductibles, coinsurance, copayments, discounts for brand-name drugs and amounts you pay while you’re in the gap.

    How To Get Repatha Prescription Assistance

    Simplefill is here to help you reduce your Repatha prescription costs! To get started saving on Repatha, apply online or call Simplefill at 1386-0206. One of our trained advocates will contact you within 24 hours to evaluate your situation and find the prescription assistance programs that are right for you.

    Simplefill will submit the applications needed for the assistance programs you qualify for, relieving you of the paperwork burden. Once youre approved, Simplefill will get you enrolled without delay. We will also assist you with ongoing prescription renewals and will find financial help for any new medications youre prescribed.

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    Medication Guides For Medicare Eligibles

    The Medication Guides are updated monthly. Links are included below to the Medicare approved Formularies and the most recent updates to the printed version of the Medication Guide for Medicare Eligibles.

    Please have your patient refer to the pharmacy endorsement or rider issued with his or her contract, Evidence of Coverage, member handbook or certificate of coverage to determine whether a particular medication listed is covered. If your patient is unsure about particular coverage/benefits or has questions about the Medication Guide, please have the member call the Customer Service number on his or her ID card. The fact that a particular drug is listed in the guide does not necessarily mean that it is covered under each members contract, Evidence of Coverage or certificate of coverage.

    1If you are not sure if your group is a small-group or large-group, please ask your HR administrator.

    How Does A Tiered Formulary Work

    Many plans have a tiered formulary where the plan’s list of drugs are divided into groups based on cost. In general, drugs in low tiers cost less than drugs in high tiers. Additionally, plans may charge a deductible for certain drug tiers and not for others, or the deductible amount may differ based on the tier.

    Formulary tiers:

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    Here’s How Much Medicare Premiums And Deductibles Will Cost In 2023

    Medicare Part B premiums will be cheaper next year, while Medicare Part A costs are getting increased.

    Katie Teague


    Katie is a writer covering all things how-to at CNET, with a focus on Social Security and notable events. When she’s not writing, she enjoys playing in golf scrambles, practicing yoga and spending time on the lake.

    If you’re planning to enroll in Medicare Part B for next year , there’s good news: The cost of premiums and deductibles will be cheaper in 2023. Those who receive Medicare Part A can expect an increase in prices, however, while Medicare Part D enrollees could see an income-related monthly adjustment.

    Each year, the Medicare Part B premium, deductible and coinsurance rates are determined following guidelines set out in the Social Security Act, the Centers for Medicare & Medicaid Services said. Due to lower-than-projected spending, which resulted in larger reserves, the CMS will decrease Part B premiums and deductibles in 2023. We’ll explain more below.

    Additionally, if you receive Social Security payments, a benefits increase for 2023 will be announced on Thursday, Oct. 13. “This means that seniors will have a chance to get ahead of inflation, due to the rare combination of rising benefits and falling premiums,” Press Secretary Karine Jean-Pierre said during a White House briefing.

    Repatha For Decreasing Ldl Cholesterol In Adults With Primary Hyperlipidemia

    Repatha is FDA-approved to decrease low-density lipoprotein cholesterol in adults with primary hyperlipidemia . For this purpose, Repatha can be used in people with heterozygous familial hypercholesterolemia .

    For treating primary hyperlipidemia, Repatha is used along with a healthy diet, as recommended by your doctor. Repatha can be used with other medications to treat your condition or used alone.

    LDL cholesterol is sometimes referred to as bad cholesterol. Repatha works to lower LDL cholesterol by helping your body get rid of LDL more effectively.

    Effectiveness for decreasing LDL cholesterol in adults with primary hyperlipidemia

    A clinical study has shown Repatha is effective for decreasing LDL cholesterol levels in adults with primary hyperlipidemia.

    The adults first took a statin drug for 4 weeks before the study began. Then in the study they were randomly assigned to take either 140 milligrams of Repatha every 2 weeks, 420 mg of Repatha once a month, or a placebo . Each person continued taking the statin they were randomly assigned to take before the study. The researchers wanted to see how the treatments compared at lowering LDL cholesterol.

    After 12 weeks:

    • people who received 140 mg of Repatha every 2 weeks with a statin had their LDL levels lowered by 63%
    • people who received a placebo every 2 weeks had their LDL levels increased by 8%

    In addition, after 12 weeks:

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    The Medicare Prescription Drug Coverage Gap

    Most Medicare Part D plans have a coverage gap, sometimes called the Doughnut Hole. This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for the drugs, up to a yearly limit. Your yearly deductible, coinsurance or copayments, and what you pay while in the coverage gap all count toward this out-of-pocket limit. The limit does not include the drug plans premium or what you pay for drugs that are not on your plans formulary or prescription drug list.

    There are plans that offer some 250coverage during the gap, like for generic drugs. However, plans with gap coverage may charge a higher monthly premium. Check with the plan first to see if your drugs would be covered during the gap.

    Once a person reaches the plans out-of-pocket limit during the coverage gap, catastrophic coverage automatically kicks in. Catastrophic coverage assures that once a person has spent up to the plans out-of-pocket limit for covered drugs, he or she will only pay a small coinsurance amount or a copayment for the rest of the year.

    It is important to note that people who get Extra Help paying drug costs will not have a coverage gap and will pay a small or no copayment once they reach catastrophic coverage.

    Average Costs For Repatha With Medicare Drug Coverage1

    Why Medicare Part D Will Drive You Nuts

    Your copay and deductible costs for any prescription drug can vary depending on what coverage stage youre in.

    Deductible stage Typical copay stage
    Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.In the deductible stage, youre responsible for the full cost of your prescription drugs.Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $480 in 2022. After you meet your Part D deductible, you enter the initial coverage period.During this phase , you pay a copayment or coinsurance for your covered medications.
    $518 $1,202 $95 $1,201

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    How Does The Part D Plan Rate For Customer Service

    The Plan Finder can show you plans star ratings, which the Centers for Medicare & Medicaid Services award to Part D and Medicare Advantage plans based on several quality measures. For Part D plans, the categories include accuracy of pricing, complaints, customer service and members experiences.

    Five stars is the highest rating, one star is the lowest. Part D plans receive star ratings based on up to 12 measures as well as an overall star rating.

    Keep in mind

    • Three ways to enroll. After you find the best prescription drug plan for your needs, you can sign up through the Medicare Plan Finder, by calling the Medicare help line at 800-MEDICARE, or by contacting the plan directly. You can find contact information for Part D plans in your area in the Medicare Plan Finder or by calling the Medicare help line.
    • But one plan at a time. If you switch to another Part D plan, the old one is automatically canceled as soon as the new coverage becomes effective. If you switch plans during the Oct. 15-Dec. 7 open enrollment period, your new coverage automatically begins Jan. 1.

    Could Repatha Affect My Kidneys Or Liver

    Repatha isnt known to affect your kidneys or liver. In clinical studies, people taking Repatha didnt have liver side effects, including changes in their levels of liver enzymes. There were also no cases of people taking Repatha developing kidney disease during treatment.

    In addition, since Repatha was released onto the market, it hasnt been reported to cause kidney or liver side effects.

    However, kidney or liver side effects can occur with statin drugs. Your doctor may prescribe a statin for you to use with Repatha.

    If you have questions about side effects of Repatha or other medications you may take with it, talk with your doctor or pharmacist. They can review your medications and determine if you have an increased risk for any side effects because of other drugs youre taking.

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    Is Repatha Covered By Medicare

    Repatha is covered by most Medicare benefit plans under Medicare Part D, which is the prescription drug benefit. Repatha is a self-injected medication thats purchased at a retail pharmacy, so it falls under Medicare drug coverage guidelines. Actual coverage will depend on your plans list of covered medications.

    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 the list price and higher than the subsidized price.

    What Is Medicare Part Extra Help

    Medicare Extra Help is a special program that provides financial assistance to people who need help affording their prescription medications. Extra Help can offer an estimated $5,100 in benefits each year to people who qualify. To be eligible, you must be receiving Medicare and have limited financial resources. If you can enroll in Extra Help, you won’t have any coverage gap or donut hole with Medicare Part D.

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    How Drug Tiers Work

    Some plans group their formulary, or Drug List, into tiers. Tiers help determine the amount youll pay for your prescription. Typically, drugs in lower tiers cost less than those in higher tiers.

    Tier 1: Preferred genericsusually includes more common, lower-cost, generic prescription drugsTier 2: Genericsusually includes higher cost generic prescription drugs and some lower-cost brand prescription drugsTier 3: Preferred brandbrand-name drugs that don’t have a generic equivalentTier 4: Non-preferred drughigher-priced brand and generic drugs with no preferred cost shareTier 5: Specialty tierthe most expensive drugs, usually used to treat complex conditions such as cancer, multiple sclerosis or rheumatoid arthritis

    If you’re currently taking prescription medication, you can use our search tool to look up a specific drug. It will tell you if the drug is covered by Humana and which tier it’s listed under. It may also offer alternatives and generics that might save you money.

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