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Evenity and Medicare - What do plans cover and how much?

Osteoporosis & Bone Health | Last Active: Dec 4 8:56am | Replies (129)
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@susanfalcon52

edwinabutterfly,
I’m unsure about this myself. I had 12 months of Evenity snd then an infusion of Reclast. No one has discussed with me what the next step is. I’m assuming that I will have another infusion of Reclast in a year or so. Then another. Then maybe a drug holiday. ????
I’m going through this process and the Evenity was a success.
My problem is my endocrinologist and my rheumatologist. Useless.
Neither have reached out to me about my dexa or anything else. They both only seem to have a basic knowledge of osteoporosis and treat the osteoporosis patients like a side hustle in their practice. When I asked the rheumatologist about ordering blood work, he had to look up the tests. He had never heard of them.
So, I have been very fortunate in that I had minimal side effects from drugs and the Evenity did its job. I just wish that I had more engagement from doctors.

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Replies to "edwinabutterfly, I’m unsure about this myself. I had 12 months of Evenity snd then an infusion..."
beanieone | @beanieone | Jul 14 9:33pm

I had Tymlos, which I couldn’t tolerate and Evenity. Prior to both meds, I had Reclast.

This past Friday, I had a second opinion consult with a second rheumatologist about my lifetime OP treatment plan. I couldn’t believe the difference in my visits from one doc to another. My first doc was, as many have stated, useless - I feel I know more about OP than he does. The second (and my new) rheumatologist is very much the educator. He not only listened to my questions and concerns, but he also gave me so much info and ordered a baseline CTX; my first doc told me that no tests were necessary except for a DEXA (which doesn’t always tell the whole story). He also thought it would be a good idea to have baseline x-rays of my femurs to monitor any changes.

I too am enjoying the benefits of Evenity and hope to ride the maintenance carousel for a bit. I’ll know this week about whether or not I can have at least one more Reclast infusion (lifetime number is high for me). This doc agreed that perhaps Prolia wasn’t the best choice for me, right now, as I am not even 70 and don’t want to think about being tied to Prolia for the long haul. It seems as though the problem with Reclast is the possibility of ONJ and spontaneous femur fractures.

I am still confused about the coverage for Evenity with Medicare Part B insurance. I need to look into the charges associated with Evenity injections as my monthly charge for them was hefty.

Thanks, all, for providing information to help me and others through this maze of treatments. Cheers!

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