Cost of Evenity injections

Posted by shula @shula, Jun 17, 2023

Does anyone know what is the out of pocket cost for Evenity if one has traditional Medicare with a supplement vs Medicare advantage program?
I was told by Aetna Medicare Advantage CONY the the out of pocket cost is $602.89
for each injection visit. They said Evenity is a tier V medication. I heard Medicare part B covers 80% and Medigap or supplement covers 20%. However I think the out of pocket cost for every Evenity visit would be costly.. appreciate a reply and thanks. Shula

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hopefullibrarian | @hopefullibrarian | Feb 28 12:32pm

In reply to @ashash "Thanks so much. if I'm reading you correctly, looks like you"ll be responsible for around $1600?" + (show)

After the assistance of $8K runs out, I'll actually pay 50% (nearly $2400) of the negotiated amount until I reach the MOOP which is fortunately pretty low compared to most. It will still hurt, but it's doable.
I had my second set of injections yesterday, and I'm a bit out of it today--so tired. If I'm not explaining things well, that's probably why.

ashash | @ashash | Feb 28 1:06pm

In reply to @rjkesal123 "I will start Evenity in January. It looks like I will use traditional Medicare, plan G..." + (show)

I understand completely.
Hope that fatigue passes quickly...

njx58 | @njx58 | Oct 2 7:27am

In reply to @rjkesal123 "I will start Evenity in January. It looks like I will use traditional Medicare, plan G..." + (show)

I'm thinking ahead to next year after I finish with Tymlos. Is Evenity administered in the doctor's office? If so, does that mean Medicare Part B covers it? If it were a take-at-home drug, then the insurance plans don't cover it and it's crazy expensive.

windyshores | @windyshores | Oct 2 8:00am

In reply to @njx58 "I'm thinking ahead to next year after I finish with Tymlos. Is Evenity administered in the..." + (show)

Evenity is two shots administered in the doctor's office and is covered by Medicare part B. Is your doctor suggesting it?

njx58 | @njx58 | Oct 2 8:18am

In reply to @windyshores "Evenity is two shots administered in the doctor's office and is covered by Medicare part B...." + (show)

No, I'm only six months into Tymlos; we haven't discussed what's next. I'm just looking ahead - if he wants to stop after 12 months or 18 months, that's 2025, and I have to choose a Part D plan before long so I want to be prepared for whatever option is next.

Helen, Volunteer Mentor | @naturegirl5 | Oct 2 9:02am

In reply to @njx58 "No, I'm only six months into Tymlos; we haven't discussed what's next. I'm just looking ahead..." + (show)

@njx58 I get Evenity at an infusion center and the cost is covered by Medicare Part B.

Colleen Young, Connect Director | @colleenyoung | Oct 2 9:31am

In reply to @njx58 "I'm thinking ahead to next year after I finish with Tymlos. Is Evenity administered in the..." + (show)

Hi @njx58, I moved your question about the cost of Evenity and insurance coverage to this existing discussion:
- Cost of Evenity injections https://connect.mayoclinic.org/discussion/cost-of-evenity-injections/

Click the link to see past posts and connect with others.

You may also be interested in this related discussion:
- Where do you get your Evenity injections?
https://connect.mayoclinic.org/discussion/where-do-you-get-your-evenity-injections/

marymj7 | @marymj7 | Oct 3 12:08pm

Does anyone know whether Medicare Part B will still pay if I delay my October 7 shots until Oct. 22? That would increase the interval from my Sept. shots from 31 days to 46 days. I really need to delay but don't want to get hit with a $14,000 bill, which is what the infusion center charges. Thanks!

Helen, Volunteer Mentor | @naturegirl5 | Oct 3 5:48pm

In reply to @marymj7 "Does anyone know whether Medicare Part B will still pay if I delay my October 7..." + (show)

@marymj7 I don't know about whether Medicare Part B will pay if you delay your injections. I recommend you call Medicare and ask that question. I do know that I had to ask my prescribing physician to contact the infusion center where I get my injections when I needed to delay my injections beyond 30 days. Forty six days is a long time between injections. Have you discussed this with your prescribing physician?

susanfalcon52 | @susanfalcon52 | Oct 4 7:09am

In reply to @marymj7 "Does anyone know whether Medicare Part B will still pay if I delay my October 7..." + (show)

Why wouldn’t Part B still cover the injections? Usually the infusion center clears it before they administer it.
I am shocked at the $14,000
price tag. Last year when I was having Evenity infusions, I could see on Medicare statement that the charge was $6,000+.