It is my understanding that many folks receive an Evenity injection in their doctor's office, not at an infusion center. I had one of my Prolia shots at an infusion center and the other one in my doctor's office.

I think the difference between processing and paying for Forteo/Tymlos and Evenity likely hinges on whether a medication is self-administered at home or administered in a clinical setting.

If at home, then you should look to your Medicare Part D plan.....what is the deductible and copay, is the drug on the formulary (apparently Tymlos is not on your Plan's formulary) and if it is not on the formulary, whether you should ask for an exception. Your doctor will need to be involved in trying to get an exception.

If the medication is given in a clinical setting, then the Medicare B process is used. This means Medicare usually pays 80% and you pay 20%. Then you look to your Medicare Supplement Plan or your Medicare Advantage plan for applicable deductibles and copays.

It seems most supplement plans pick up your entire share of the cost of Evenity because it is a Medicare B medication. The supplement plans do not cover Medicare Part D drugs for which you have a separate Plan.

I am hoping that if my understanding about Medicare B drugs and Medicare D drugs is incorrect, someone will set me straight.

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