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Insurance company is denying Evenity

Osteoporosis & Bone Health | Last Active: 1 day ago | Replies (66)

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Profile picture for osteopatient2026 @osteopatient2026

You need to get your doctor to write a “letter of medical necessity” directly to the insurance company…it helps if your doctor is a specialist like an endocrinologist or rheumatologist…ask for a referral. If you have had a previous fracture possibly due to your OP …I think I posted somewhere what I did in November of 2025. Hope this helps.
If your BMD, FRAX score and T scores are in the osteoporosis range moderate to severe…you should qualify…however BCBS may have changed their requirements since 2025.

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@osteopatient2026
I am seeing an Endocrinologist. She did tell me that insurance prefers you have a fracture before they ok Evenity. Which is crazy. I haven’t had any fractures. 🤞🏻I’m going to call insurance myself tomorrow and see what they say. Then I’ll call Dr back tell them to do a peer to peer review or what you suggested. I don’t understand why she isn’t suggesting something other than Prolia? Just because the insurance said so?