← Return to Evenity and Medicare - What do plans cover and how much?

Discussion
Comment receiving replies
@lbtw

I don’t know if any of you can offer a suggestion — but thought I’d give this group a try. I just started Evenity this past week and it is covered by my current insurance. In August I will be on Medicare and I’m trying to find a drug plan - part D - as I research them — none cover Evenity — with a 17,000+$ cost. Any suggestions. Thanks in advance

Jump to this post


Replies to "I don’t know if any of you can offer a suggestion — but thought I’d give..."

Evenity falls under Part B.

Okay — that helps me understand. Thank you

@lbtw I have Traditional Medicare. Evenity is covered under Part B however I have to go to a clinic with an Infusion Center to get my injections. In order to Evenity to be covered I could not get the injections at my PCP (primary care provider) office.

Thank you for that info

This is a guess re PCP Offices Amgen says Medicare covers it in an office setting. However, this is the guess part, PCP's may not want to deal with the administrative aspects so default to using infusion centers. Most likely you can continue receiving Evenity where you are now receiving it.

I am on traditional Medicare. I recently had my 12th injections of Evenity. Because I had them at an infusion center, they were covered under Part B.
100% covered. When I receive the EOB from Medicare explaining what they paid for what and how much, the Evenity bill is heart stopping.
$5,000+. So, in the past year Medicare has paid more than $60,000 for my Evenity treatment. I am very grateful, but still know that Big Pharma is a monster.

lbtw @lbtw I'm on traditional Medicare and Evenity is paid for under Part B not Part D. I have Medicare supplemental also so I pay nothing. I get my shots in the doctors office. I do not believe there is any requirement for an infusion center. My doc is a rheumatologist. I do not know but I would guess that Evenity could be given in a primary care docs office if they were into osteoporosis enough to want to do that. Also I am a male and some say Medicare won't approve for men. Well they did for me, with some effort. I think there is a problem in that Medicare does not pre-approve osteoporosis meds. Some types of drug you can get pre-approval, as in a written document I guess but that is not the case for osteoporosis. Anyway I eventually got approved but not I think ahead of the submittal for payment after the first shot. Some of this was not visible to me but that's the best I can piece it together. They are paying for it I'm certain of that.

I paid $0.00. Medicare paid $5,000+

@jolie2525 I have Traditional Medicare. I received my Evenity injections at an infusion center. This is a Part B designation as outpatient medical and the injections were administered by the infusion center's nurses. My Evenity injections were completely covered (at $5000/month!). When my endocrinologist prescribed Evenity he told me that I would have to go to an infusion center at a medical center/hospital for these injections. He said this is not a Part D prescription designation.

If you have a Medicare Advantage Plan (which is not Traditional Medicare) then your planjolie2525 I have Traditional Medicare. I received my Evenity injections at an infusion center. This is a Part B designation as outpatient medical and the injections were administered by the infusion center's nurses. My Evenity injections were completely covered (at $5000/month!). When my endocrinologist prescribed Evenity he told me that I would have to go to an infusion center at a medical center/hospital for these injections. He said this is not a Part D prescription designation.

If you have a Medicare Advantage Plan (which is not Traditional Medicare) then your plan is administered by the insurance company that you signed up with such as United Health Care or Blue Cross/Blue Shield. to administer your Medicare. If you called your insurance company and they said Evenity is not covered then I suggest you call them again and tell them that Part B does pay for Evenity and that since Traditional Medicare covers this under Part B they are required to do the same.

Thank You so much for your help. I did speak with someone at my insurance company and they said they only covered 80% and my responsibility is &545 a month but can’t afford that. Maybe it’s because Aetna in Florida doesn’t cover it?