PRALUENT: Available at a 60% lower list price
The lower list price is expected to help reduce PRALUENT out-of-pocket costs for many patients, especially those on Medicare.
- Most Medicare patients can expect to pay between $25 and $150 per month*
- Eligible commercial patients may still access the PRALUENT copay offer, which may reduce the copay to as little as $0 (restrictions apply)†
*Subject to plan adoption and tier placement determination.
†Eligible patients with commercial insurance not funded through a government healthcare program such as Medicare, Medicaid, or TRICARE are subject to program terms and restrictions.
PRALUENT is empowering more:
Simplified prior authorization process for some plans1
NDC with a 60% lower list price2
Only PCSK9i that offers 2 powerful dosing options3‡
‡Based on patient’s efficacy needs.
The recommended starting dose of PRALUENT is 75 mg once every 2 weeks administered subcutaneously or alternatively 300 mg once every 4 weeks (monthly) for patients who prefer less frequent dosing. The majority of patients achieve sufficient LDL-C reduction with the 75 mg dosage. If the LDL-C response is inadequate, the dosage may be adjusted to the maximum dosage of 150 mg administered every 2 weeks.
Programs to help patients pay for PRALUENT
Commercially Insured Patients
As little as a $0 copay for PRALUENT§||
If eligible, your commercially insured patients can use the MyPRALUENT® Copay Card to pay the out-of-pocket costs for their PRALUENT treatment, including deductibles, copays, and coinsurance (up to a maximum assistance of $3,500 each year). Terms and conditions apply.II
- The MyPRALUENT Copay Card can be used yearly
- Patients can submit for reimbursement if they paid their copay in full within 90 days
§Eligible patients with commercial insurance not funded through a government healthcare
program such as Medicare, Medicaid, or TRICARE subject to program terms and restrictions.
||Subject to a maximum copay assistance amount from MyPRALUENT® of $3,500 a year.
Uninsured or Medicare Patients
Uninsured or Medicare Part D patients who meet income restrictions.
Are your patients eligible? Click below to register and submit the
PASS form electronically or call 1-844-855-PASS (1-844-855-7277). If your patient is eligible and approved, your patient's prescription will be forwarded to the PASS pharmacy for processing.
Extra Help Program
If your patients are faced with limited income and resources, there's a US government-funded program that may help pay some of their Medicare prescription drug costs. It's called the Extra Help Program and it offers:
- Reduced Medicare Part D premiums
- No cost share in the coverage gap or "donut hole"
- Lower drug copays
Clinical documentation and prior authorization (PA) tips
Many health plans require a PA for PRALUENT. Here are some helpful tips to keep in mind when gathering your patient’s clinical information and preparing a PA submission.
Items to include when submitting a PA
Statement of Medical Necessity
Important patient information to collect:
Specific ICD-10 codes and details to support your patient’s diagnosis
Complete history of lipid-lowering therapy, including doses, frequency, and dates of use
- Be sure to include proof of maximally tolerated high-intensity statin(s) if required
- Also note if your patient tried and failed on ezetimibe
Contraindications or any intolerance/adverse reactions to lipid-lowering therapies
Lab work within the last 30 days showing lipid profile test results
Documentation of family history and any comorbid conditions
Proof of lifestyle modification (eg, diet, exercise, smoking cessation counseling)
Completed and signed plan-specific PA form
Prior Authorization Tips for PRALUENT
Before submitting any documentation to the health plan, be sure that it’s accurate and up to date to avoid unnecessary denials.
Getting patients started
iAssist is an electronic platform that simplifies access to help get PRALUENT to appropriate patients. This free, all-in-one tool:
Sends prescriptions and completed prior authorization forms directly to the pharmacy and payer
May help reduce incomplete prior authorization submission
CoverMyMeds is a secure, HIPAA-compliant online tool that automates PA requests for most health plans and PBMs at most pharmacies—at no cost.