Insurance company is denying Evenity

Posted by rudysmom @rudysmom, 14 hours ago

I just got a call from my Dr stating my insurance company BCBS is denying Evenity. They want me to do Prolia first. I told the person who called me that Prolia is the one drug I didn’t want to do. That there is research showing if I do that first the Evenity won’t be as effective, also that Prolia rebounds quickly. She agreed with me, but this is what insurance company wants done first. I said it’s ridiculous they get to dictate my healthcare. Again she agreed. She told me to think about it and call them back.

I was diagnosed back in February with a -2.7 in spine. Hips are still in osteopenia, don’t remember those numbers. I decided in May to go on Evenity and it’s been a battle ever since. A couple years ago I tried Fosomax when I was still in osteopenia and had reaction of severe pain in my right hip, so I stopped taking it after 3 weeks. I’m afraid if I can’t tolerate Fosomax I’m not going to tolerate Prolia. Not sure what to do at this point. 😣

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rudysmom | @rudysmom | 10 hours ago

In reply to @osteopatient2026 "@rudysmom What are your T Scores" + (show)

@osteopatient2026
Spine is -2.7 and hips are -2.0

andi77 | @andi77 | 10 hours ago

My spine is -3.6 (neck -3.8) and I was denied Evenity.
My bone specialist initiated an appeal for me due to my "Severe Osteoporosis" and low blood pressure (daily injections like Tymlos & Forteo lower BP and can frequently cause palpitations, which I have a history of).

Unfortunately, your insurance most likely denied Evenity because your DXA results are fortunately not so bad and bisphosponates like Prolia, Fosamax, etc. are the typical protocol for your score.

None of these medications are without side effect nor possible adverse reactions.
You may ask your provider to help you with an appeal, but if it's denied once again, you may just have to try Prolia and prove that it's not indicated for you.

I wish you the best with pursuing what you desire.

samclembeau | @samclembeau | 5 hours ago

My understanding is that as long as you tried one of the others first and could not tolerate it you would be able to do evenity. Did your doctor mention that you already tried another drug? If not maybe your Endo can reapply for the evenity with that added.

gravity3 | @gravity3 | 4 hours ago

Is your doctor advocating for you with the insurance company? I am so sorry that you are being treated like this. How far up the food chain did you go? What is their dispute process?