Cholesterol Medication Cost Calculator
Understand the real costs of cholesterol treatment options. This tool compares the annual costs of statins versus PCSK9 inhibitors based on your insurance coverage.
Current Medication Information
Cost Comparison
Insurance Coverage Info
Your insurance typically covers PCSK9 inhibitors with prior authorization. Many patients use copay cards to reduce costs to $0.
Key Considerations
- PCSK9 inhibitors cost $5,000-$14,000/year without insurance
- Statins cost $4-$50/month with insurance
- 87% of insurers require prior authorization for PCSK9 inhibitors
- Copay assistance programs can reduce PCSK9 inhibitor costs to $0 for eligible patients
When it comes to lowering cholesterol, two main types of drugs dominate the conversation: statins and PCSK9 inhibitors. Both work to reduce LDL - the "bad" cholesterol - but they’re not the same. One is a daily pill with decades of use behind it. The other is an injection you give yourself, expensive but powerful. Choosing between them isn’t about which is "better" - it’s about which fits your body, your risk, and your life.
How They Work: Different Paths, Same Goal
Statins have been around since the late 1980s. They work by blocking an enzyme in your liver called HMG-CoA reductase. This enzyme is responsible for making cholesterol. When you take a statin, your liver makes less cholesterol overall, and it also pulls more LDL out of your blood. That’s why your LDL levels drop - typically by 30% to 50%, depending on the dose and type. PCSK9 inhibitors work differently. They’re not made to stop cholesterol production. Instead, they block a protein called PCSK9, which normally tells your liver to destroy LDL receptors. When you block PCSK9, your liver keeps more of these receptors on its surface. More receptors mean more LDL pulled out of your bloodstream. The result? LDL reductions of 50% to 61%, often higher than even the strongest statins. This difference matters because it means PCSK9 inhibitors can work even when statins don’t - especially in people with genetic conditions like familial hypercholesterolemia, where the liver can’t clear LDL efficiently no matter how much you suppress production.Side Effects: What You Actually Feel
Statins are effective, but they come with side effects that are real and common enough to make people stop taking them. About 5% to 10% of users report muscle pain, weakness, or cramps. In rare cases, this can lead to a serious condition called rhabdomyolysis. Many people describe it as a constant, dull ache that doesn’t go away, even after switching statins. Memory fog and fatigue are also reported, though studies show these are less common than patients think. PCSK9 inhibitors don’t cause muscle pain. That’s one of their biggest advantages. In clinical trials and patient reviews, 79% of users say they didn’t experience any muscle-related issues after switching from statins. There’s no evidence they cause memory problems or liver damage either. But they’re not side-effect-free. The most common issue? Injection site reactions. Redness, itching, or mild swelling where you inject the drug happens in about 10% to 15% of users. It’s usually temporary and doesn’t require stopping treatment. Some people feel anxious about giving themselves shots - especially if they’ve never done it before. And because these drugs are injected, not swallowed, they require training and a certain level of comfort with needles. One key safety difference: statins slightly increase the risk of hemorrhagic stroke in certain people - especially those with a history of stroke or high blood pressure. A 2023 UCLA study found a 22% higher risk. PCSK9 inhibitors show no such link across 36 trials. For someone already at risk for bleeding in the brain, that’s a meaningful advantage.Outcomes: Does Lower LDL Mean Fewer Heart Attacks?
Lowering LDL is good, but does it actually save lives? Yes - and both drugs prove it. The FOURIER trial (evolocumab) and ODYSSEY OUTCOMES (alirocumab) showed that adding a PCSK9 inhibitor to statin therapy reduced heart attacks, strokes, and the need for heart surgery by about 15% to 20% over two to three years in people with existing heart disease. That’s not a small gain - it’s life-changing for someone who’s already had a heart attack. But here’s the catch: statins have been shown to reduce heart attack risk by 25% to 30% over five years in people with high cholesterol or diabetes. And they’ve been proven to cut overall death rates. That’s something PCSK9 inhibitors haven’t yet matched in long-term mortality studies - though they’re close. The 2019 JAMA Cardiology study by Nicholls et al. found that adding evolocumab to statins reduced cardiovascular events by 27% in patients with stable heart disease and LDL over 70 mg/dL. That’s powerful. But statins have been doing this for 35+ years with millions of patients tracked. PCSK9 inhibitors have about 10 years of data. We know they work. We just don’t know yet if they’ll outlive statins in terms of long-term survival.
Who Gets Which Drug?
You’re not a candidate for both. You’re a candidate for one - or maybe both. Statins are still the first choice for almost everyone. If you have high cholesterol, diabetes, or a family history of early heart disease, your doctor will start you on a statin. Why? Because they’re cheap, safe, and proven. PCSK9 inhibitors are reserved for specific cases:- You have familial hypercholesterolemia and your LDL stays above 100 mg/dL despite maximum statin doses.
- You’ve tried two or more statins and still get muscle pain, fatigue, or liver issues.
- You’ve had a heart attack or stroke and your LDL is still above 70 mg/dL even on high-dose statins.
- You’re at very high risk and your doctor wants to get your LDL below 55 mg/dL.
Cost and Access: The Real Barrier
A month’s supply of generic atorvastatin costs $4 to $10. Rosuvastatin? Around $12. Even brand-name statins rarely go over $50 without insurance. PCSK9 inhibitors? $5,000 to $14,000 a year. That’s $400 to $1,200 a month. Most insurers won’t pay unless you’ve tried and failed on statins. They’ll ask for lab results proving your LDL is still too high. They’ll want proof you can’t tolerate statins. They’ll require prior authorization - a process that can take weeks. About 87% of U.S. insurers require this level of documentation before approving PCSK9 inhibitors. That’s why many patients give up. One Reddit user wrote: "I got approved after 11 weeks. By then, I’d already paid $1,800 out of pocket. I stopped. I couldn’t afford it." Manufacturers help. Amgen and Sanofi offer copay cards that can bring monthly costs down to $0 for eligible patients. They also provide free injection training and 24/7 nursing support. But these programs have income limits. If you make too much, you’re on your own.
What About New Options?
There’s a third player now: inclisiran (brand name Leqvio). It’s also a PCSK9 blocker - but it’s given as an injection only twice a year. That’s a game-changer for people who hate daily pills or monthly shots. It was approved by the FDA in 2021, and early data shows it lowers LDL by about 50%, similar to the older PCSK9 inhibitors. Even more exciting? Oral PCSK9 inhibitors are in Phase II trials. Merck’s MK-0616, for example, reduced LDL by 60% in early studies - and it’s a pill. If approved, it could replace injections entirely and cut costs dramatically. These aren’t science fiction. They’re coming. And they’ll change how we think about cholesterol treatment.Real Stories, Real Choices
A 42-year-old woman with familial hypercholesterolemia had an LDL of 286 mg/dL on high-dose rosuvastatin. After adding alirocumab, it dropped to 58. She stopped having chest pain. She got off her EKG monitor. "I feel like I got my life back," she told the FH Foundation. A 68-year-old man switched from atorvastatin to evolocumab after 10 years of muscle pain. "I couldn’t walk my dog without stopping. Now I hike. No pain. No fog. Just better numbers." But another man, 59, got approved for evolocumab - then got hit with a $320 monthly copay. He couldn’t pay. He went back to statins. His LDL rose to 130. He’s now waiting for a new insurance plan. The data is clear. The science is solid. But the system isn’t.Bottom Line: It’s Not Either/Or - It’s Right Now
Statins are the foundation. They’re cheap, safe, and proven. If you can take them and tolerate them, they’re still your best bet. PCSK9 inhibitors are the upgrade. If you’re at high risk, can’t tolerate statins, or your LDL won’t budge - they’re not just an option. They’re a lifeline. And their safety profile makes them especially valuable for people with stroke risk or muscle sensitivity. The future is combination therapy - statin plus PCSK9 inhibitor - for those who need it. And eventually, oral versions will make this easier. But right now? The decision comes down to three things: your risk level, your tolerance for side effects, and your ability to afford it. Talk to your doctor. Ask for your LDL numbers. Ask about your options. And don’t accept "that’s all we can do" if you’re still at risk. Your heart isn’t just a number. It’s your life. And there’s a path forward - even if it’s not the one you expected.Can I take PCSK9 inhibitors instead of statins?
Yes - but only if you meet specific criteria. PCSK9 inhibitors are not first-line for most people. Doctors usually try statins first because they’re cheaper and have decades of safety data. You’d typically only switch to PCSK9 inhibitors if you can’t tolerate statins, have familial hypercholesterolemia, or your LDL stays too high despite maximum statin therapy. Some high-risk patients get both - statin plus PCSK9 inhibitor - for maximum LDL reduction.
Do PCSK9 inhibitors cause muscle pain like statins?
No. Unlike statins, PCSK9 inhibitors do not cause muscle pain, weakness, or cramps. This is one of their biggest advantages. In clinical trials and patient surveys, 79% of users who switched from statins reported complete relief from muscle symptoms. That’s why they’re often the go-to option for people with statin intolerance.
Are PCSK9 inhibitors safe for long-term use?
Current data shows they are. Studies tracking patients for up to five years show no new safety concerns. There’s no increased risk of diabetes, liver damage, or cognitive issues. The main risks are mild injection site reactions and the possibility of developing antibodies - though this is rare and doesn’t seem to affect effectiveness. Long-term data beyond five years is still being collected, but so far, the profile is very favorable.
Why are PCSK9 inhibitors so expensive?
They’re biologic drugs - made from living cells - which makes them harder and costlier to produce than chemical pills like statins. When they first launched, prices were set around $14,000 a year. Since then, manufacturers have lowered prices and introduced copay programs. Some patients now pay $0 out of pocket. But without insurance or assistance, the full cost remains high. The real barrier isn’t the drug itself - it’s the insurance system’s strict approval rules.
Do I need to refrigerate PCSK9 inhibitors?
Yes. Most PCSK9 inhibitors (like evolocumab and alirocumab) must be stored in the refrigerator between 36°F and 46°F (2°C to 8°C). They can be kept at room temperature (up to 77°F) for up to 14 days if needed for travel. Always check the package insert. Injections should never be frozen or exposed to direct sunlight. Some newer versions, like inclisiran, have more flexible storage rules.
How often do I need to inject PCSK9 inhibitors?
Most PCSK9 inhibitors are injected either every two weeks or once a month. Alirocumab (Praluent) is typically given every two weeks. Evolocumab (Repatha) can be given every two weeks or every four weeks. A newer option, inclisiran (Leqvio), is injected only twice a year - once, then again three months later, then twice yearly after that. The frequency depends on the specific drug and your doctor’s recommendation.
Can I switch back to statins after using PCSK9 inhibitors?
Yes. There’s no permanent change to your body from using PCSK9 inhibitors. If you stop them, your LDL will gradually rise again - just like it would if you stopped a statin. Some patients switch back if they can’t afford the drug, if side effects occur, or if their risk level changes. Others stay on PCSK9 inhibitors long-term because they work better and cause fewer side effects. The decision is always personalized.