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Insurance company is denying Evenity

Osteoporosis & Bone Health | Last Active: 2 hours ago | Replies (32)

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@gravity3
I have to call Dr office back today and ask. Hopefully I can talk to someone else in the office. Person who called me yesterday wasn’t very friendly. Just kept saying insurance company wants me to do Prolia and need to make appointment.

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Replies to "@gravity3 I have to call Dr office back today and ask. Hopefully I can talk to..."

@rudysmom What about teriparatide (Forteo)? It is now available in generic form, so it is less expensive for the insurance company than Evenity but it is also an anabolic bone-building drug. Maybe insurance would approve this?

I would ask my doctor about teriparatide, and I would self-pay if insurance denied that and assuming that I could swing the cost, which many can not. Teriparatide costs about $850 per month via self-pay and you need to do it for 2 years. But you only have one set of bones and, as you said, anabolic bone-building drugs are not as effective after taking denosumab (brand Prolia) so there is no going back once you get far down the Prolia path.

A long shot, but there was one person on this site who got a big discount from the drug company when she did self-pay of Evenity (romosozumab) after insurance denial. Others have said that there are no discounts if you are on Medicare and I assume that includes Medicare Advantage if that is how you have your Blue Cross Blue Shield insurance. Some bone experts are now saying it is only needed to take Evenity for 6 months instead of the full year so that can help reduce cost, but it will still be a huge financial investment. So investigate that as well (Dr. Benjamin Leder for example.)
https://www.costplusdrugs.com/medications/teriparatide-560-mcg_2_24ml-solution-pen-injector-2_24/