Before estimating a PCSK9 inhibitor injection budget in Korea
PCSK9 inhibitor injections are prescription medicines used within a broader lipid-lowering plan to reduce LDL cholesterol.
In South Korea, Repatha contains evolocumab and Praluent contains alirocumab, with several strengths and dosing intervals that produce different pen counts.
Because the medicines are costly and National Health Insurance reimbursement has detailed clinical gates, a one-pen price does not tell the full budgeting story.
This guide uses benefit-ceiling prices and HIRA reimbursement criteria verified on July 20, 2026.
It separates homozygous familial hypercholesterolemia, heterozygous familial hypercholesterolemia, atherosclerotic cardiovascular disease, and the strict reimbursement definition of statin intolerance.
It also distinguishes ordinary covered copays, the V900 rare-disease special-case rate for registered HoFH-related covered care, and full self-pay outside the reimbursement criteria.
Coverage checklist
Review age, diagnosis evidence, prior statin and ezetimibe therapy, cardiovascular risk, and LDL-C response without presenting the result as an approval.
Pen-count planning
Convert every-two-week, every-four-week, and monthly dosing schedules into a conservative number of pens for the selected planning period.
Patient-cost scenarios
Compare ordinary covered copays, a qualifying HoFH V900 10% share, and 100% self-pay when the entered checklist is not met.
What this calculator does and does not decide
The Korean calculator above is an input-based planning tool.
It calculates a displayed LDL-C reduction rate, checks the selected HIRA pathway, estimates a regimen pen count, and applies a simplified patient rate to the drug ceiling price.
It can help a patient prepare records and questions before speaking with a clinician, pharmacy, hospital billing team, or insurer.
Included
- Five Repatha and Praluent regimen presets
- Drug-only list cost and simplified patient share
- Patient-group-specific reimbursement checkpoints
- LDL-C percentage-reduction and absolute thresholds
- HoFH V900 registration scenario
- Same-period comparison across regimens
Not included
- Diagnosis, prescription, dose selection, or treatment advice
- A guaranteed HIRA or provider reimbursement decision
- Visit, laboratory, dispensing, or injection-service fees
- A provider-set price for non-covered treatment
- Private insurance, tax-credit, or ceiling-refund approval
- Predicted LDL-C response or cardiovascular benefit
A green checklist means only that the entered values match the modeled public criteria.
Actual reimbursement can depend on diagnosis documentation, laboratory dates, the recorded maximum tolerated statin dose, ezetimibe use, duplicate-event rules, prescription details, and the claim submitted by the provider.
What a PCSK9 inhibitor is
PCSK9 participates in the degradation of LDL receptors on liver cells.
Blocking PCSK9 allows more LDL receptors to be recycled and can increase removal of LDL cholesterol from the bloodstream.
Evolocumab and alirocumab are monoclonal-antibody injections given under the skin, but their approved and reimbursed use remains part of an individualized treatment plan that may also include diet, statins, ezetimibe, and other interventions.
Approval is not the same as reimbursement
A medicine can be prescribed within its Korean label while still falling outside the narrower HIRA reimbursement criteria.
HIRA pages state that use outside the listed criteria is charged at the full drug cost, which is why the calculator applies a 100% patient share when an entered checklist is not met.
2026 Repatha and Praluent price anchors
The figures below are benefit-ceiling drug-price anchors, not a complete hospital bill.
Repatha 420 mg monthly is modeled as three 140 mg pens per administration.
Every-two-week dosing uses 26 administrations per 12 months, while every-four-week dosing uses 13 administrations per 12 months.
South Korea PCSK9 inhibitor ceiling prices and twelve-month drug-only costs| Regimen | Ingredient | Per-pen price | 12-month pens | 12-month list cost |
|---|
| Repatha 140 mg every 2 weeks | evolocumab | KRW 120,914 | 26 | KRW 3,143,764 |
| Repatha 420 mg monthly | evolocumab | KRW 120,914 | 36 | KRW 4,352,904 |
| Praluent 75 mg every 2 weeks | alirocumab | KRW 128,304 | 26 | KRW 3,335,904 |
| Praluent 150 mg every 2 weeks | alirocumab | KRW 128,308 | 26 | KRW 3,336,008 |
| Praluent 300 mg every 4 weeks | alirocumab | KRW 256,618 | 13 | KRW 3,336,034 |
Repatha 140 mg was verified at KRW 120,914 per pen with a price effective January 1, 2026.
Praluent was verified at KRW 128,304 for 75 mg, KRW 128,308 for 150 mg, and KRW 256,618 for the 300 mg pen.
A user can replace the selected regimen price with a current provider or tariff amount, while comparison rows retain their official default anchors.
HoFH reimbursement pathway
The modeled homozygous familial hypercholesterolemia pathway applies to evolocumab, not alirocumab, under the current HIRA criteria reviewed for this calculator.
The patient must be at least age 12, have HoFH confirmed through the listed clinical or genetic route, have used a maximum tolerated statin with ezetimibe, and have an insufficient LDL-C response.
For this pathway, insufficient response means less than a 50% reduction from baseline or current LDL-C 70 mg/dL or higher.
Clinical confirmation route
The HIRA text describes pre-treatment total cholesterol above 500 mg/dL or LDL-C at least 300 mg/dL together with xanthoma before age 10 or findings consistent with HeFH in both parents.
The treating team must determine whether the record satisfies the formal wording.
Genetic confirmation route
The HIRA text lists LDLR, LDLR-AP1, APOB, and PCSK9 genetic confirmation.
The calculator uses one confirmation checkbox and does not interpret a genetic report or variant classification.
Selecting Praluent for an HoFH scenario produces a failed ingredient check and 100% self-pay in this model.
That behavior reflects the reviewed reimbursement page, not a statement that a clinician may never use alirocumab for any purpose.
HeFH reimbursement pathway
The heterozygous familial hypercholesterolemia pathway applies from age 18.
HIRA requires confirmation at Simon Broome possible or higher, or Dutch probable with a score of at least 6.
The patient must have used a maximum tolerated statin together with ezetimibe and still show less than a 50% LDL-C reduction or current LDL-C 100 mg/dL or higher.
A family history alone is not represented as formal confirmation in the calculator.
Before selecting the confirmation box, check whether the clinician has documented the relevant Simon Broome or Dutch criteria.
The tool does not calculate a Dutch score because the complete diagnostic assessment requires clinical and family-history details beyond a cost planner.
Boundary example
Baseline LDL-C 200 mg/dL and current LDL-C 100 mg/dL is exactly a 50% reduction, but the current value still meets the absolute LDL-C 100 mg/dL threshold.
Baseline LDL-C 198 mg/dL and current LDL-C 99 mg/dL is exactly a 50% reduction and is below the absolute threshold, so the modeled insufficient-response check is not met.
ASCVD very-high-risk pathway
The atherosclerotic cardiovascular disease pathway applies from age 18 and requires a very-high-risk pattern.
The model treats the risk gate as met when there are at least two major ASCVD events or conditions, or one major ASCVD item plus at least two high-risk factors.
Maximum tolerated statin plus ezetimibe must also be documented, followed by less than a 50% reduction or current LDL-C 70 mg/dL or higher.
Major ASCVD items and high-risk factors used in the Korean reimbursement checklist| Major ASCVD items | High-risk factors |
|---|
| Acute coronary syndrome within the previous year | Age 65 or older |
| Prior myocardial infarction not duplicating recent ACS | HeFH |
| Ischemic stroke | CABG or PCI history not counted as a major item |
| Symptomatic peripheral artery disease | Diabetes or hypertension |
| Abdominal aortic aneurysm | CKD with eGFR 15-59 mL/min/1.73 m² |
| — | Current smoking |
| — | LDL-C at least 100 mg/dL despite combination therapy |
| — | History of congestive heart failure |
Symptomatic peripheral artery disease is described with claudication and an ankle-brachial index below 0.85, or prior revascularization or amputation.
Avoid counting one clinical event in more than one major category, and do not count a CABG or PCI history again as a high-risk factor when it has already been represented by a major event.
Ask the treating team to confirm the official count rather than reconstructing it from memory.
The strict statin-intolerance pathway
The reimbursement wording is narrower than everyday use of the phrase statin intolerance.
It requires prior use of at least two existing lipid-lowering medicines including a statin, plus muscle symptoms with creatine-kinase elevation and myositis or rhabdomyolysis.
The calculator therefore uses one explicit confirmation checkbox for the complete strict definition and does not infer eligibility from ordinary muscle aches, a preference to avoid statins, or a single discontinued prescription.
Do not use this field to self-diagnose a medicine adverse effect.
Muscle pain, weakness, dark urine, or other concerning symptoms require clinical review, and urgent symptoms should be handled through appropriate medical care rather than a cost calculator.
How the LDL-C response rule is calculated
Reduction (%) = (baseline LDL-C − current LDL-C) ÷ baseline LDL-C × 100
The HIRA wording uses an OR rule.
A response is insufficient when the reduction is below 50%, or when current LDL-C remains at or above the group-specific absolute threshold.
HoFH and ASCVD use LDL-C 70 mg/dL, while HeFH uses LDL-C 100 mg/dL.
Below 50%
A 49.9% reduction satisfies the modeled insufficient-response branch even if the current LDL-C is below the absolute threshold.
Exactly 50%
Exactly 50% does not satisfy the percentage branch, so the current absolute LDL-C value becomes decisive.
Baseline zero
A zero baseline cannot produce a percentage. The calculator displays unavailable and uses only the absolute threshold branch.
Use laboratory values that the treating team considers comparable and appropriate for the reimbursement assessment.
The calculator cannot determine whether a test was taken after a sufficient treatment period, whether adherence was documented, or whether a baseline date is acceptable for a claim.
HoFH V900 special-case registration and the 10% rate
The Korea Disease Control and Prevention Agency rare-disease helpline lists homozygous familial hypercholesterolemia, E78.00, with special-case code V900.
The current Special Copayment Calculation Standard, Ministry of Health and Welfare Notice No. 2026-101 effective May 1, 2026, provides a 10% patient share for registered rare-disease patients receiving related covered care.
The calculator applies that 10% rate only when the selected group is HoFH, the reimbursement checklist is met, and the user confirms V900 registration.
HeFH, ASCVD, and ordinary hyperlipidemia do not receive V900 automatically.
Even an HoFH registration does not convert unrelated treatment or a non-covered medicine into qualifying special-case care.
Confirm registration validity, the relationship between the prescription and registered disease, and the actual claim treatment with the provider.
National Health Insurance Act Article 44 establishes patient cost sharing, and Enforcement Decree Article 19 points to the detailed copay schedule.
The calculator uses simplified ordinary outpatient reference rates of 30%, 40%, 50%, or 60% when the special-case rate is not selected, but the provider claim remains authoritative.
Pen-count and drug-cost formulas
Every 2 weeks
ceil(months × 26 ÷ 12)
Used for Repatha 140 mg and Praluent 75 mg or 150 mg.
Every 4 weeks
ceil(months × 13 ÷ 12)
Used for the Praluent 300 mg planning preset.
Repatha 420 mg monthly
months × 3 pens
Each monthly 420 mg administration uses three 140 mg pens.
List cost = unit price × required pens
Patient cost = round(list cost × applied patient rate)
Monthly average = round(patient cost ÷ planning months)
The every-two-week and every-four-week formulas round up to produce a conservative monthly planning quantity.
They do not use an actual start date, so a calendar-accurate count can differ near the beginning and end of the selected period.
Prescription quantity, refill timing, missed-dose handling, and dose adjustment must come from the clinician and dispensing provider.
Worked cost examples
Example 1: covered ASCVD scenario
Assume baseline LDL-C 150 mg/dL, current LDL-C 90 mg/dL, one major ASCVD item, two high-risk factors, and documented maximum tolerated statin plus ezetimibe.
The reduction is 40%, and the very-high-risk pattern is met.
Repatha 140 mg every two weeks needs 26 pens in 12 months, producing KRW 3,143,764 at the list price.
A simplified 30% covered share is KRW 943,129, leaving a modeled NHIS share of KRW 2,200,635 before other bill items.
Example 2: HoFH with V900
Assume all HoFH evolocumab checkpoints are met and related-care V900 registration is confirmed.
Repatha 420 mg monthly uses 36 of the 140 mg pens over 12 months, producing KRW 4,352,904 at the list price.
A 10% special-case share rounds to KRW 435,290.
Removing the registration confirmation makes the calculator use the selected ordinary covered rate instead, while choosing Praluent makes the current HoFH ingredient check fail.
Example 3: HeFH absolute threshold
Baseline LDL-C 200 mg/dL and current LDL-C 100 mg/dL is a 50% reduction.
Because the current value is still at the HeFH threshold, the insufficient-response branch is met.
If the current value were 99 mg/dL with an exact 50% reduction, neither the percentage branch nor the absolute branch would be met.
Example 4: outside the checklist
If an ASCVD user enters one major item and only one high-risk factor, or cannot confirm statin and ezetimibe combination therapy, the modeled checklist fails.
The selected drug list cost is then treated as 100% patient-paid regardless of the ordinary copay option.
This does not estimate a provider-set non-covered markup and should not be presented as a quote.
Step-by-step use
- Select the prescribed or discussed regimen.The Korean calculator resets the unit price to the verified ceiling-price default whenever the regimen changes.
- Choose the documented patient group.Distinguish HoFH from HeFH and do not substitute a general hyperlipidemia label for a formal reimbursement pathway.
- Enter comparable baseline and current LDL-C values.Use records that the treating team considers valid for assessment after the relevant prior treatment.
- Confirm pathway-specific records.Review FH confirmation, maximum tolerated statin and ezetimibe, ASCVD counts, or the strict statin-intolerance definition.
- Set the budget period and rate scenario.Confirm V900 only for registered HoFH-related covered care; otherwise choose the ordinary outpatient reference that best matches the expected setting.
- Read unmet items before reading the price.Bring the checklist, laboratory report, prescription plan, and provider estimate to a professional review.
Practical planning scenarios
Prepare for a reimbursement conversation
List the LDL-C dates, statin names and doses, ezetimibe use, cardiovascular events, procedures, and high-risk factors so the clinical team can check documentation gaps.
Compare a 12-, 24-, or 36-month horizon
Change the planning period to see drug-only cash-flow exposure while remembering that continued prescription and reimbursement are never guaranteed by the tool.
Understand V900 impact
Compare a qualifying HoFH-related 10% scenario with an ordinary covered rate, then verify registration and claim treatment with the provider.
Discuss schedule logistics
Use pen counts to ask about storage, prescription quantity, travel, refill timing, and administration support without choosing a dose based on cost alone.
Why the actual bill can differ
The model starts from a drug ceiling price and applies a simple percentage.
A real claim can include consultation, laboratory monitoring, prescription, dispensing, administration, and other covered or non-covered items.
The care setting, inpatient or outpatient status, pharmacy route, rounding rules, prescription quantity, price changes, and the patient’s eligibility category can all affect the final amount.
- Ask for an itemized estimate that separates the medicine from visits, tests, and administration.
- Confirm whether the prescription is covered, selectively covered, or fully self-paid before treatment.
- Check whether V900 appears on the relevant claim rather than assuming that a registry card applies to every service.
- Keep receipts and detailed statements if considering private indemnity insurance or a Korean medical-expense tax credit.
- Treat the annual out-of-pocket ceiling as a separate post-claim issue and not as an automatic discount inside this calculator.
The Korean annual out-of-pocket ceiling generally concerns eligible covered patient payments, not arbitrary non-covered charges.
The calculator deliberately does not subtract a ceiling refund because it lacks the calendar-year household, premium tier, excluded-item, and cumulative-claim information needed for a reliable estimate.
Storage, administration, and safety boundaries
PCSK9 inhibitor pens require handling according to the Korean product information and the dispensing provider’s instructions.
Follow the labeled refrigeration, light-protection, room-temperature, and disposal rules for the exact product supplied.
Do not freeze a pen, expose it to unsuitable heat, shake it, change the strength, combine doses, or alter a missed-dose schedule without professional instructions.
- Check the brand, strength, expiry, appearance, and packaging before use.
- Receive injection training and follow approved injection-site rotation guidance.
- Ask how long the supplied product may remain outside refrigeration and never guess from another brand.
- Report injection-site reactions or suspected allergic reactions to the care team.
- Seek appropriate urgent help for severe breathing difficulty, facial swelling, fainting, or another emergency symptom.
- Use the calculator only for cost planning, never for deciding whether to start, stop, or increase treatment.
Frequently asked questions
Does every person with high cholesterol pay only 30%?＋
No. PCSK9 reimbursement uses patient-group, age, diagnosis, prior-treatment, LDL-C, and risk criteria. Use outside those criteria can be charged at the full drug cost.
Does LDL-C below 70 mg/dL always fail the coverage check?＋
No. For HoFH and ASCVD, a reduction below 50% can satisfy the insufficient-response branch even when current LDL-C is below 70 mg/dL. Every other pathway requirement must still be met.
Does HeFH automatically qualify for the V900 10% rate?＋
No. This calculator reserves V900 for registered homozygous familial hypercholesterolemia-related covered care. HeFH is not automatically assigned that rate.
Why does Repatha 420 mg monthly use three pens?＋
The preset models a 420 mg administration as three 140 mg pens. Verify the exact prescribed presentation and quantity because available packaging and instructions can change.
Is ordinary muscle pain enough to mark statin intolerance?＋
No. The modeled HIRA definition requires at least two lipid-lowering medicines including a statin and muscle symptoms with CK elevation plus myositis or rhabdomyolysis.
Why is Praluent shown as full self-pay in an HoFH comparison?＋
The current alirocumab reimbursement page reviewed for this tool does not include the modeled HoFH pathway, while the evolocumab page does. This is a reimbursement-model distinction, not prescribing advice.
Does the price include tests and visits?＋
No. It is a drug-only ceiling-price estimate. Consultation, laboratory, dispensing, administration, and other covered or non-covered charges are outside the calculation.
Can the result prove that HIRA will approve treatment?＋
No. Only the relevant clinician, provider claim process, and insurer review can determine actual coverage. The result is a preparation checklist.
Official sources and verification dates
Reimbursement logic was checked against the HIRA evolocumab and alirocumab criteria effective March 1, 2024 under Notice No. 2024-37 and still presented as the current criteria when reviewed on July 20, 2026.
The legal basis was cross-checked through the Korean Law Information Center OPEN API using National Health Insurance Act Article 44, Enforcement Decree Article 19, and the current Special Copayment Calculation Standard.
HoFH rare-disease status and V900 were checked against the Korea Disease Control and Prevention Agency rare-disease helpline.
Prices, reimbursement wording, special-case rules, and available product presentations can change after the verification date.
Recheck the current HIRA list, MFDS product information, KDCA registry information, and provider quote at the time of treatment.
Turn records into a better coverage and cost conversation
Enter the documented patient group, comparable LDL-C results, prior therapy, and planned regimen to organize questions and estimate drug-only exposure.
Let the treating clinician, provider, and HIRA process determine diagnosis, prescription, and actual reimbursement.