Repatha Patient Assistance Application: How to Apply, Requirements & Benefits

If you take Repatha® (evolocumab) to lower cholesterol but have difficulty affording it, the Repatha Patient Assistance Program may be able to help you get it for free. The Repatha Patient Assistance Program, part of the Amgen Safety Net Foundation (ASNF), supports eligible patients in the United States who have little or no prescription coverage.

This ensures that people will not be able to take cholesterol-lowering medication prescribed by their doctor due to financial constraints.

Provider	Amgen Safety Net Foundation
Cost to Patient	$0
Primary Requirement	Income < 500% FPL
Duration	12 Months (Renewable)
Contact Phone	1-800-932-3060

What is Repatha Patient Assistance Program?

The Repatha Patient Assistance Program is a support program that helps eligible patients receive Repatha at no cost. It is designed for uninsured people whose insurance does not cover Repatha, or who cannot afford the out-of-pocket cost. This program is managed by the Amgen Safety Net Foundation, a non-profit organization funded by Amgen.

Benefits of the Repatha Assistance Program

If you are eligible, here are some of the key benefits of joining this program:

• Free medication: Qualified patients receive Repatha at no charge.
• Easy process: Simple application steps with doctor assistance.
• Yearly renewal: Continue receiving medication if you still meet the requirements.
• No hidden costs: There are no fees or copays involved.

Eligiblity Requirements

You may qualify for the Repatha Patient Assistance Program if you meet the following criteria:

1. You live in the U.S. or its territories.
2. You have a valid prescription for Repatha from a licensed U.S. healthcare provider.
3. You are uninsured or underinsured.
4. The household income must be at or below 500% of the Federal Poverty Level (FPL). For 2026, the approximate annual gross income limits are:
   • 1 Person: $79,800
   • 2 People: $108,200
   • 3 People: $136,600
   • 4 People: $165,000
   • (Note: Limits are higher for residents of Alaska and Hawaii).

Required Documents

To apply for the program, you’ll require:

• A completed Repatha application form (signed by both you and your doctor).
• Proof of income, such as recent pay stubs, W-2 form, or tax return.
• Proof of residency such as a driver’s license or utility bill.
• Identity Verification: A valid Social Security Number (SSN)
• Insurance information, if applicable, or documentation of coverage denial.
• Prescription information, including dosage and frequency.

From the doctor (prescriber):

• Fulfilled prescription: The application contains a special page that the doctor must sign, which serves as a legal prescription.
• Medical necessity: Documentation showing the diagnosis (e.g., primary hyperlipidemia or HoFH) and that other treatments (e.g., statins) have been tried or are not appropriate.

Repatha Patient Assistance Application PDF

To make the Application process easier, Amgen provides a downloadable Repatha Patient Assistance Application PDF on its official website. You can find it on the Amgen Safety Net Foundation page, under the Repatha section. The PDF contains sections for both the patient and the healthcare provider to complete and sign.

How to Fill out the Application PDF

1. Download the Repatha Patient Assistance Application PDF from the official website.
2. Print the Application form and fill in all required sections (patient and prescriber).
3. Attach supporting documents like proof of income and insurance.
4. Submit the completed form by fax or mail.

Fax Number: 1-833-959-1409 (This is the primary way to submit).

Mailing Address: Amgen Safety Net Foundation P.O. Box 15980 Phoenix, AZ 85060

Support Phone: 1-800-932-3060 (Monday – Friday, 8 a.m. – 8 p.m. ET).

You can also ask your doctor’s office for help printing or submitting the form if needed.

Read More: Novo Nordisk Patient Assistance Application

How to Apply for the Repatha Assistance Program Application

The application is a collaborative effort between you and your healthcare provider. Follow these steps carefully:

1. Download the Form: Visit the official website AmgenSafetyNetFoundation.com and download the Amgen Safety Net Foundation Patient Application.
2. Patient Sections: Fill out pages 1 through 3 of the form, including your personal, income, and insurance information. Don’t forget to sign the Patient Authorization and Certification section.
3. Physician Sections: Your doctor will need to fill out the Prescribing Physician and Facility Information section of the form.
4. Submission: Once both sections are completed, fax the form and all required financial documents to 1-833-959-1409.
5. Review: The review process typically takes 5 to 7 business days. Both you and your healthcare provider will receive notification of the decision by mail or phone.

Renewal Process

You will need to renew your application once a year. The foundation usually sends a reminder before your renewal date, asking for updated income and insurance details.

1. For the Safety Net Foundation ($0 Cost)

• Timeframe: Start 60 days before your 12-month approval ends.
• The Forms: Download the 2026 Patient Application from AmgenSafetyNetFoundation.com.
• Documentation: Attach your latest Tax Return (1040) or Social Security statement.
• Medical: Have your doctor sign the Prescription Section of the new form.
• Submit: Fax all pages to 1-833-959-1409.

2. For the Co-Pay Card ($5–$25 Cost)

• Timeframe: Benefits reset every January 1st.
• Re-enroll: Call 1-844-REPATHA or visit the Repatha website to “reactivate” your card for the new year.
• Update Pharmacy: Ensure your pharmacist has the new Group/ID numbers if they changed during renewal.

Other Financial Support Options

If you don’t qualify for the free assistance program, Amgen also offers:

• Amgen SupportPlus Co-Pay Program: Helps insured patients lower their co-pay costs.
• SupportPlus Services: Offers help with insurance coverage, prior authorization, and reimbursement.

For more details, call 1-888-REPATHA (1-888-737-2842).

Conclusion

The Repatha Patient Assistance Program provides vital support to patients who cannot afford their cholesterol medication. With an easy-to-download Repatha Patient Assistance Application PDF and a simple submission process, getting help has never been easier.

If you’re having trouble paying for Repatha, take a few minutes to apply through the Amgen Safety Net Foundation. It could make a big difference in your heart health and peace of mind.

For more details on the Patient Assistance Program, let’s read it.