This budget impact analysis evaluated the 1-year costs of adding the PCSK9 inhibitor alirocumab to the formulary of a hypothetical US health plan with 1 million members for treatment of heterozygous familial hypercholesterolemia. It was estimated that 1,120 of the estimated 1,600 members with the condition would be treated with alirocumab due to inadequate LDL control on current therapies. The total drug spending was projected to be $11.7 million, increasing the overall per member per month cost by $0.976 and the per treated member per month cost by $7,320. While alirocumab is more effective than other options, the high annual cost of $10,000