The $14,600 yearly price of the drug, which is injected under the skin once every two weeks, is a stunner. Yet for some, that might be a bargain.

Todd DeRuchie’s current cholesterol-lowering regimen costs $8,000 a month, paid by his insurer. The treatment, known as apheresis, requires that the construction business owner go to a clinic and sit for hours while his blood flows into a machine that cleanses it of LDL cholesterol. Two weeks later, the LDL is back again, and he has to repeat the process.

The new drug can allow him to avoid all that for a fraction of the price.

“Cost is in the eye of the beholder,” said Daniel Soffer, DeRuchie’s cardiologist at the University of Pennsylvania. Praluent, developed by Sanofi and Regeneron Pharmaceuticals, and other drugs in the pipeline like it, known as PCSK9 inhibitors, are “a game changer,” he added.

Most people with high cholesterol can successfully lower it with statins, which can cost pennies a day. But DeRuchie has a form of heterozygous familial hypercholesterolemia, or FH, an inherited condition that causes extremely high cholesterol, and is much more troublesome. It is a genetic condition that affects an estimated 1 million Americans.

Doctors say FH is more common than cystic fibrosis or Down syndrome, yet largely unrecognized. Only 1 to 10 percent of people with FH know they have it, often because doctors do not think of it when patients have high cholesterol. A genetic test for the condition, which costs $800 to $1,000, is generally not covered by health insurance.

People with heterozygous FH have a twentyfold increased risk of heart disease. Men who are not treated have a 50 percent chance of having a heart attack by age 50. Untreated women have a 30 percent chance of having a heart attack by age 60.

Most cannot reduce their cholesterol to optimum levels even if they take several powerful drugs, said Joshua Knowles, a Stanford University cardiologist and chief medical adviser of the FH Foundation, an advocacy group.

The question now for health insurers and heart disease researchers is whether the advent of PCSK9 inhibitors will change this picture.

The diagnosis of FH is a clinical one, Soffer said. “Most in the medical community are not lipidologists,” Soffer said. “They tell these patients they are eating too much french fries and ice cream.”