Alirocumab (Praluent)

How Medicare covers it

Part D (self-injected pen used at home — the forms in the Part D formulary file). Part A during a covered inpatient stay. No Part B clinician-administered row for alirocumab in the CMS Part B spending file used by this desk.

What it treats

Alirocumab (Praluent) is a PCSK9 inhibitor injection. It is indicated to reduce the risk of major adverse cardiovascular events (coronary heart disease death, heart attack, stroke, or unstable angina requiring hospitalization) in adults at increased risk for these events, and — as an addition to diet and exercise — to reduce LDL cholesterol in adults with hypercholesterolemia, in adults and children 8 years and older with heterozygous familial hypercholesterolemia (HeFH), and in adults with homozygous familial hypercholesterolemia (HoFH).

What it is for, in depth

From the label's Indications section, Praluent has two kinds of jobs. First, cardiovascular risk reduction: lowering the risk of coronary heart disease death, myocardial infarction, stroke, and unstable angina requiring hospitalization in adults already at increased risk — the post-heart-disease population. Second, LDL lowering as an adjunct to diet and exercise: adults with hypercholesterolemia generally; heterozygous familial hypercholesterolemia in adults and children 8 and older; and homozygous familial hypercholesterolemia in adults — the inherited conditions where LDL is extremely high from birth and diet plus statins are not enough. Where it fits on the treatment path: an add-on injectable used when LDL remains too high on maximally tolerated oral therapy (typically a statin, often with ezetimibe), or when statins cannot be tolerated — given at home by pre-filled pen every 2 or 4 weeks. Forms in the formulary data behind this page: Praluent pens of 75 mg/mL and 150 mg/mL only.

How it works

Alirocumab is a human monoclonal antibody (an IgG1 antibody made by recombinant DNA technology) that targets PCSK9. PCSK9 is a protein that binds LDL receptors on liver cells and promotes their degradation. By blocking PCSK9 from binding those receptors, alirocumab increases the number of LDL receptors available to clear LDL ('bad') cholesterol from the blood, thereby lowering LDL-C levels.

How it is taken

A subcutaneous (under the skin) injection from a single-dose pre-filled pen (75 mg/mL or 150 mg/mL), given into the thigh, abdomen, or upper arm. In adults with hypercholesterolemia including HeFH: 75 mg once every 2 weeks, or 300 mg once every 4 weeks (two 150 mg pens); if the LDL response is inadequate on the monthly schedule, the dose may be adjusted to 150 mg every 2 weeks. In adults with HeFH undergoing LDL apheresis, or with homozygous FH: 150 mg every 2 weeks, given without regard to apheresis timing. The LDL-lowering effect can be measured as early as 4 weeks after starting.

Common side effects

The label extract's adverse-reactions section points to hypersensitivity reactions as the reaction class discussed in its warnings and does not reproduce a frequency table in the extracted text. The medicine is an injection, so the practical tolerability questions are injection-site tolerance and allergic reactions; the label's safety content concentrates on serious hypersensitivity (below).

Serious warnings

This label has no boxed warning. Its single warning class is hypersensitivity: hypersensitivity vasculitis (inflammation of blood vessels), angioedema (deep swelling), and other hypersensitivity reactions requiring hospitalization have been reported. If signs or symptoms of a serious hypersensitivity reaction occur, treatment is discontinued, the patient is treated to the standard of care, and monitored until the signs and symptoms resolve. A history of a serious hypersensitivity reaction to alirocumab or any of its ingredients is a contraindication.

Who should be careful

Anyone with a history of a serious hypersensitivity reaction to alirocumab or any Praluent ingredient (contraindicated); anyone who develops signs of serious allergy (vasculitis, angioedema, reactions needing hospital care) — treatment is stopped. For pregnancy, the label states the available data are insufficient to evaluate drug-associated risk, and notes that like other IgG antibodies alirocumab crosses the placenta, increasingly near term.

Major interactions

The pinned Praluent label carries no drug-interactions section naming interacting medicines — as a monoclonal antibody it is not cleared through the liver enzyme pathways that drive most small-molecule interactions. Its labeled cautions are about hypersensitivity only. Readers should still tell their care team about all medicines, but no label-listed interaction adjustments apply to this product.

Cost and saving notes

Praluent is a high-cost specialty biologic, and the CMS picture behind this page is unusual: only about 1 in 11 Part D plans list it, and where listed it most often sits on a low tier in the aggregation (see the tier section) — plan listing, not tier, is the real barrier for most readers. If a plan does not list it, the prescriber can request a formulary exception; the related PCSK9 products are the formulary alternatives plans usually prefer. Extra Help can assist people with limited income.

Why it is in its tier

Alirocumab (Praluent) sits on Tier 2 in 51.84% of the plans that list it (268 of 517 listing plans). Tier 2 is the generic tier — low copays. The data-visible drivers: It is a brand-only product with no generic version in the formulary data, and the CMS dashboard puts its average Part D spending at about $3,683 per beneficiary for 2024 — a mid-cost drug, which matches where plans place it. Only 9.41% of Part D plans list it at all, so many readers will find their plan does not list it and covers a similar drug instead. The tier shown is the most common one; individual plans vary.

Sources

• PRALUENT (ALIROCUMAB) INJECTION, SOLUTION [SANOFI-AVENTIS U.S. LLC] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Alirocumab Injection

What official patient guides say

Alirocumab comes as a solution (liquid) in a prefilled syringe and a prefilled dosing pen to inject under the skin, once every 2 or 4 weeks, exactly as directed. After 4 to 8 weeks, your doctor may increase your dose depending on your response. It helps to control cholesterol levels but does not cure these conditions. Continue to use it even if you feel well, and do not stop without talking to your doctor. Each pen or syringe holds one dose and is never reused or mixed with another medication; if your dose needs more than one, use them one right after the other into different spots. An injection may take up to 20 seconds. Inject into your thigh, upper arm, or stomach, but not within 2 inches of your belly button or near your waistline, use a different spot each time, and do not inject into skin that is sore, red, bruised, swollen, sunburned, hard, hot, infected, or injured. Let the pen or syringe warm to room temperature for about 30 to 40 minutes before use, and do not put it back in the refrigerator after it has warmed up. The medication should look clear to pale yellow with no floating particles, and the pen or syringe should not be shaken. Put used needles, syringes, and devices in a puncture-resistant container. If you miss a dose and it is within 7 days, inject it as soon as you remember and go back to your original schedule — except on the every-4-week schedule, if more than 7 days have passed, inject a dose and start a new 4-week schedule from that date. On the every-2-week schedule, if more than 7 days have passed, skip the dose and wait for your next scheduled dose. Do not inject a double dose, and call your doctor if you miss a dose and have questions. Store it in the refrigerator in its original carton, protected from light; do not freeze it. It may also be kept at room temperature up to 77°F (25°C) in the original carton for up to 30 days; after 30 days it must be discarded. Keep it out of reach of children.

Source: MedlinePlus — Alirocumab Injection

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 258.06544 per unit (PRALUENT 150 MG/ML PEN) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 517 list Alirocumab (Praluent) — 9.4% of plans. Most of those plans put it on Tier 2: 268 plans, 51.8% of the plans that list it. Other plans place it on Tier 3 (193 plans), Tier 4 (35 plans) or Tier 1 (21 plans). For example: Wellcare Simple Value (HMO-POS) puts it on Tier 2; Wellcare Dual Reserve (HMO-POS D-SNP) puts it on Tier 2; CareOregon Advantage Plus (HMO D-SNP) puts it on Tier 3. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.