Payer split, pharmacy channel, product mix, and cost-per-day analysis for PCSK9 inhibitors. MEPS 2023 captures evolocumab (Repatha) only — 0 records for alirocumab (Praluent) and inclisiran (Leqvio). 2023 Medical Expenditure Panel Survey, prescribed medicines file (HC-248A). 154 fills · 29 unique patients · 4,328 days supplied.
PCSK9 class coverage: Three PCSK9 inhibitors are approved in the US — Repatha (evolocumab), Praluent (alirocumab), and Leqvio (inclisiran). MEPS 2023 captured 0 records for Praluent and Leqvio. Praluent has a small US market share relative to Repatha; Leqvio (approved Dec 2021) was in early commercial launch in 2023 and is administered as a twice-yearly in-office injection — a dispensing model largely absent from pharmacy-based prescription records.
Data source: AHRQ Medical Expenditure Panel Survey (MEPS) 2023 — Prescribed Medicines File (HC-248A). Independent analysis, not affiliated with or endorsed by AHRQ.
154
Prescription fills in 2023
evolocumab (Repatha) only
29
Unique patients
avg 5.3 fills / patient / year
$621
Avg cost per fill
total expenditure all payers
$95.7K
Total 2023 expenditure
across all 154 fills
Payer split
Proportional attribution method. Each metric splits each fill's values across payers by dollar share — eliminating double-counting across payers. Dollar amount — who bears the financial cost (already exclusive by construction: each dollar belongs to exactly one payer). Attributed fills — each fill is split as fractional fill-equivalents proportional to payer dollar share. A fill where Medicare pays 80% and patient pays 20% counts as 0.8 for Medicare and 0.2 for patient. Sums to exactly 154 fills. Attributed days — same proportional split applied to days supplied. Sums to exactly 4,328 days with zero overlap between payers.
Cross-metric finding: Medicare's dollar share (50.3%) exceeds its attributed fill share (45.3%) and day share (44.2%); Private insurance is the reverse (41.4% of dollars, 47.7% of days). Normalizing to total therapy days: Medicare contributes $11.11/day vs. Private's $9.15/day — a 21% gap. Patient OOP is consistent at ~8% across both dollar and day metrics, ruling out differences in cost-sharing structure as the explanation. Medicare-covered Repatha fills therefore carry a higher total cost per day of therapy. Two explanations remain possible and have not been disentangled: (1) product mix — Medicare patients may use more of the shorter-supply SureClick formulation (~$21/day) and fewer Pushtronex/injectable fills (~$15–18/day); (2) price differences — Medicare Part D and private plans may negotiate different net prices for the same formulation. A payer × formulation breakdown would be needed to separate these effects.
Pharmacy channel
Channel = PHARTP1 (primary pharmacy type per fill). PCSK9 inhibitors are predominantly dispensed through provider offices and specialty/mail-order channels — consistent with injectable biologics requiring clinical administration or cold-chain handling.
By product (Repatha formulation)
Formulation
Fills
Avg $/fill
Avg days
Repatha (SureClick autoinjector)
76
$559
26
Repatha SureClick (alt)
67
$556
28
Repatha Pushtronex (monthly)
6
$1,374
90
Repatha (standard injectable)
5
$1,526
84
Pushtronex is the on-body monthly infusor — higher unit cost but monthly rather than bi-weekly dosing. Standard injectable fills (84-day supply) likely represent quarterly administration or compounding.
Methodology notes: Dollar values are MEPS-reported expenditures in nominal 2023 USD, not adjusted for inflation. Attributed fills and attributed days use proportional attribution: each fill's values are allocated across payers by dollar share, ensuring all three metrics sum to 100% with no double-counting. 11 of 154 fills have missing RXDAYSUP and are excluded from days calculations only; these fills are included in dollar and fill attribution. No zero-expenditure (PAP) fills were observed for this drug. MEPS captures self-reported prescription fills; fills obtained through manufacturer patient assistance programs may be underreported. Sample size (n=29 patients) is small — figures are directionally useful but should not be used for statistical inference. Alirocumab (Praluent) and inclisiran (Leqvio) returned 0 records in MEPS 2023. Bempedoic acid (Nexletol) is not a PCSK9 inhibitor but a related lipid-lowering agent — excluded here.