Anyone taken Evenity (romosozumab) for Osteoporosis?

Posted by arlene7 @arlene7, May 27, 2020

Has anyone taken Evenity? I understand it’s only been on the market for a little over a year. I’m hoping it will help with my severe osteoporosis. Any information is helpful.

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

@sandrac

Regular Medicare (80%) plus G Supplement (20%) pays the whole amount, including the charge by institution who is giving the injection.

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Doctor's office or infusion center?

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@gravity3

Is there any possibility that it has been submitted incorrectly? Have you contacted the billing dept at your doctor's medical organization or could the doctor have coded it incorrectly? Never hurts to ask. Let the doctor know that financially you may not be able to continue if this is the amount each month. I don't think many doc's know what is being charged for these drugs.

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@gravity3 good idea, I will call Mayo on Monday! I just feel like something isn't right, I was charged a $20 copay at the Mayo infusion center. I called my insurance and her English was hard to understand, all she could do was give me phone numbers to get financial support. Thank you

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@windyshores

Medicare Advantage does not have supplements.

@naturegirl5 I am surprised an infusion center will do those quick shots!

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@windyshores , I am required to get them at an Infusion center!

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@windyshores

Medicare Advantage does not have supplements.

@naturegirl5 I am surprised an infusion center will do those quick shots!

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@windyshores When my Mayo Clinic endocrinologist prescribed Evenity we talked about where I could get the injections. He informed me that this particular could not be administered at my doctor's office. I know, it sounds odd, but I found out the same from my primary care physician. The infusion center at medical center where I get the injections also administers Evenity to other patients.

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On the Evenity website, there are numerous mentions of the injections being given at a doctor's office. Maybe some doctors choose to allow an infusion center to manage the administration. I am fairly sure the fragility clinic I consulted would give the injections in an office setting.

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@connibar

@windyshores , I am required to get them at an Infusion center!

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This entire picture is crazy. First thing, it seems to me you need to find out how your insurance processed the claim. Was is processed under Part B or Part D. Look carefully at your Explanation of Benefits and then talk with your insurer again.....ask to be transferred to someone who you can understand.

What are your deductibles? Do you have a deductible for your health plan (would include Part B benefits) and if so, what is it? You likely have a deductible for Part D, often referred to as the drug plan. What is it?

And how much of your deductible had you met when your Evenity claim was processed. Could this first Evenity payment include a very large deductible that might not be part of subsequent payment obligations.

Every Advantage plan seems to have slight differences making it very difficult to compare apples to apples when we discuss things like this on Connect.

IF you still cannot make heads or tails about how your claim was processed, consider getting help understanding how the claim was handled and what to expect next about your responsibility.

You might get this type of help from either your State Health Insurance Program https://www.shiphelp.org/ or from the Medicare Rights Center https://www.medicarerights.org/about.

By the way, who is your insurer? Do you know whether you received prior approval for the Evenity? Are your medical providers 'in-network' or 'out of network?'

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@gravity3

Doctor's office or infusion center?

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Doctor’s office at UNC-Chapel Hill, part of the hospital system. But I have also had Reclast at the infusion center there and they paid the same.

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@sbcher

It doesn't make sense. I tried to get a coupon from Evenity for a discount, but once they found out I have Medicare it was not covered. Most people that need this medication are under Medicare. It's a shame!

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sbcher,
Traditional Medicare does cover Evenity. Because the injections are given in an infusion center, they are covered.
Medicare Advantage plans have different rules and I can’t address those.

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@sandrac

Doctor’s office at UNC-Chapel Hill, part of the hospital system. But I have also had Reclast at the infusion center there and they paid the same.

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Thanks. I'm in Moore county.

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@normahorn

On the Evenity website, there are numerous mentions of the injections being given at a doctor's office. Maybe some doctors choose to allow an infusion center to manage the administration. I am fairly sure the fragility clinic I consulted would give the injections in an office setting.

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I get mine at my endocrinologists office

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