Anyone taken Evenity (romosozumab) for Osteoporosis?

@rjd Thank you! I really appreciate your advice and the links! I just feel like there is some horrible mistake being made. I printed out the chat with the $20 copay quote and on Monday, I will be making more calls. I have been very happy with my plan until now, this is my 3rd year o this plan. I have United Healthcare Advantage plan, Even though I did not need prior auth, I did get that, too! My providers are all in network. I do not have a deductible, either.

@susanfalcon52 policies of Medicare Advantage are not relevant since it is Medicare Part B that covers Evenity given in a doctor's office or infusion center. People with Medicare Advantage are covered by Part B for Evenity, not their private plans. I pay 20%.

It is doubtful whether Medicare covers Evenity BECAUSE injections are give in an infusion center. Windy' injections are Medicare covered and I understand her to say that her injection is given in her doctor's office.

It is my understanding that when you have Medicare Advantage, also know as a Medicare Part C plan, it subsumes both Part A and Part B for plan participants. I think of this role as providing an umbrella under which Parts A(hospitalization), B ( doctors and outpatient treatment,) and often Part D (medication not covered under Part B) are administered.

Although an Advantage Plan must provide the same benefits as Medicare Parts A& B, I think it can play around a bit with the procedure for obtaining those benefits. For example, the expanding trend of prior approval might be just that sort of 'playing around.'

I thought I could provide a cite to where I read this on one of the Medicare.gov myriad websites, but cannot locate it now.

I was told by my supplemental insurance that Evenity is fully covered by my plans (Medicare plus plan F).

Instead of conjecture I suggest contacting your insurance company.

@rjd In my experience your post is not correct. Medicare Part B is not in the umbrella of Medicare Advantage and my Evenity was covered by regular Medicare B, not my Advantage Plan. I cannot have a supplement with my Advantage Plan so I paid 20%. I don't know but it seems those with regular Medicare plus a good supplement may pay little or nothing. After all my Advantage Plan is only $79/month and it covers Part D meds, dental, vision, hearing.

I agree with @normahorn that this discussion is probably better conducted with our insurance companies!

I would never dispute what anyone said regarding Medicare Advantage plans and Evenity coverage, because I do not understand those plans. I was only speaking to my experience which is with traditional Medicare. I was not offered the option of receiving Evenity at the doctor’s office. I have been given that option for Reclast, however.

Connibar DID contact her insurance company....twice. First contact they told her a copay amount on which she relied to seek treatment. The second contact was when she learned she was responsible for an amount considerably larger than what she was first told.

Welcome to the world of Medicare Advantage.

Perhaps you might review the Explanation of Benefits for the Evenity and see who issued it. If it came from the government,, then it was processed by Medicare. If it came from your Medicare Advantage insurer, then that is likely the answer.

People with a Medicare supplement (aka Medigap) pay a monthly premium that is often far greater than what those who have Medicare Advantage pay, with some Advantage plans having no monthly premium.

A good overview of how all the various Medicare Plans relate to one another can be reviewed here. https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-coverage-overview/original-medicare

Medicare is unnecessarily complex and makes it difficult to identify anyone who really knows what is going on so an intelligent decision about treatment costs can be made.

Again, for those of us with Medicare Advantage Plans, Medicare Advantage does not pay for Evenity. It is covered by regular Medicare Part B for us as well, We pay a premium for part B of Medicare, which can be automatically taken out of social security ($174.70/month). This is in addition to the premium for our Advantage plans. There are no Medigap supplementals available for Medicare Advantage plans. Most Advantage Plans cover drugs, but not those given in the office, which are covered by Part B.