Heart Attack Survivors Gain Lifeline with New Drug Coverage

MISSISSAUGA, ON – April 07, 2026 – Thousands of heart attack survivors in Ontario and Quebec will gain access to a powerful cholesterol-lowering medication following a major expansion of public drug coverage, a move medical experts are hailing as a critical step forward in preventing recurrent cardiovascular events.

The governments of Ontario and Quebec have announced they will now publicly reimburse Repatha® (evolocumab), a potent injectable drug, for eligible patients who have recently suffered an acute coronary syndrome (ACS)—a term for situations where blood supply to the heart muscle is suddenly blocked, such as a heart attack. This decision provides a crucial treatment option for high-risk individuals whose cholesterol levels remain dangerously high despite the use of standard therapies like statins.

Each year, more than 60,000 Canadians experience their first heart attack. For these patients, the journey doesn't end when they leave the hospital. They face a significantly elevated risk of another heart attack, stroke, or death, particularly in the first few years. A key factor in this risk is persistently high LDL-C, often called "bad cholesterol."

"After leaving the hospital, patients still need ongoing treatment to support their heart health," said Dr. Shaun Goodman, Associate Head of Cardiology at St. Michael's Hospital, in a statement. "Lowering LDL cholesterol is a critically important part of that care, and access to appropriate therapies helps ensure patients receive the standard-of-care treatment recommended by their physicians."

A Critical Gap in Post-Event Care

For decades, statins have been the cornerstone of cholesterol management. However, a substantial portion of patients either cannot tolerate the side effects, which can include debilitating muscle pain, or do not achieve the aggressive cholesterol targets needed after a major cardiac event.

Data shows the stark reality of this treatment gap. In Ontario, an estimated 42 per cent of patients with a history of an ACS remain above the LDL-C threshold recommended by Canadian lipid guidelines, even with treatment. For these individuals, the risk is not theoretical. Studies indicate that among Canadian patients who remain above the target cholesterol level after a heart attack, nearly half will suffer another cardiovascular event within about three years, and one in four will die from cardiovascular causes.

Patient advocacy submissions to national health bodies have painted a vivid picture of this struggle. Many individuals report trying multiple types of statins, only to be forced to stop due to side effects that impact their quality of life. This leaves them feeling vulnerable and anxious, knowing their risk for another life-threatening event remains high. The expanded access to a new class of drugs offers a much-needed alternative.

A New Standard of Proactive Treatment

The new provincial policies reflect a growing consensus that more aggressive, early intervention is needed. Quebec became the first province to act, listing Repatha on its public formulary on February 4 for eligible patients up to 24 months after an ACS. Ontario has now followed, with its updated Ontario Drug Benefit (ODB) program covering the drug for eligible patients within 52 weeks of their event.

Repatha belongs to a class of drugs known as PCSK9 inhibitors. It works differently than statins, using a monoclonal antibody to block a protein that degrades LDL receptors in the liver. This action dramatically increases the liver’s ability to clear bad cholesterol from the bloodstream, often achieving reductions of 50-60% on top of what statins can provide.

"Expanding access to additional lipid-lowering therapies gives clinicians the opportunity to act sooner and help patients avoid potentially preventable future events," noted Dr. Jeffrey Habert, a family physician and Assistant Professor at the University of Toronto.

This sentiment was echoed by Amgen Canada, the drug's manufacturer. "Extending coverage and broadening eligibility could help more patients access appropriate lipid-lowering therapy early after an acute event, when timely treatment may be critical for reducing future cardiovascular risk," said Daniel Jun Martinez, Executive Medical Director of Amgen Canada.

The Economic Equation of Saving Lives

While the clinical benefits are clear, the introduction of high-cost specialty drugs like Repatha into public formularies always raises economic questions. PCSK9 inhibitors carry a significant price tag, with annual costs running into the thousands of dollars per patient.

Initial health-economic analyses in Canada were cautious, suggesting that at their introductory prices, the drugs were not cost-effective for widespread use. Some early studies estimated that a significant price reduction of 50% or more would be needed to meet standard cost-effectiveness thresholds. This created a barrier to broader public funding, limiting access to only the most extreme cases of genetic high cholesterol.

However, the economic conversation is evolving. More recent analyses, focusing specifically on the highest-risk secondary prevention patients—like those who have just had a heart attack—are proving more favourable. When factoring in the immense long-term costs of treating repeat heart attacks, strokes, and subsequent hospitalizations, the upfront investment in a powerful preventative therapy becomes more justifiable. The economic burden of cardiovascular disease in Canada is estimated to be as high as $30 billion annually in direct and indirect costs. Preventing even a fraction of these events can lead to substantial downstream savings for the healthcare system.

A Patchwork of Access Across Canada

The leadership shown by Ontario and Quebec now casts a spotlight on the rest of the country, where access to these advanced therapies remains inconsistent. This creates a "postcode lottery" for healthcare, where a patient's ability to access a potentially life-saving treatment depends on their province of residence.

Experts hope this move will create a ripple effect. "Quebec's pioneering role in expanding access to care for patients who have suffered an acute coronary syndrome reflects a growing focus on managing cardiovascular risk following a cardiac event," said Dr. Jean C. Grégoire, an Interventional Cardiologist at the Montreal Heart Institute. "It is essential that other provinces continue their efforts to ensure more patients have access to appropriate and effective treatment following an event."

This expansion also solidifies Amgen's position in a competitive market that includes other advanced therapies like Praluent (alirocumab) and the newer siRNA therapy Leqvio (inclisiran). Securing public reimbursement in Canada's two largest provinces is a major strategic victory that will likely drive adoption of Repatha.

As Ontario and Quebec implement these new policies, the focus will shift to tracking real-world outcomes and costs. For the thousands of patients who can now access this therapy, however, the change is immediate. It represents a new line of defense against a disease that remains Canada’s second-leading cause of death and a renewed sense of hope for a healthier future after a heart attack.