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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Profile picture for Helen, Volunteer Mentor @naturegirl5

@patwerthman I have Traditional Medicare. I received my injections at an infusion center and Part A and B paid for all the costs. I never have a co-pay with Traditional Medicare. They either pay for some procedure or they do not. By the way, I also have a Part G Supplemental Plan that I pay for. This Part G fills in the gaps not covered by Part B of Traditional Medicare.

If a person has an Advantage Plan (sometimes called Medicare Advantage) then the insurance company is a private company that contracts with Medicare. Medicare Advantage may or may not pay for Evenity.

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@naturegirl5 good to know. And check on before this occurs for me. Thank you

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The Medicare supplement Plan G only covers the remaining 20% for whatever Medicare paid 80%. If Medicare didn't cover it at all, then the supplement plan won't cover it either. Initially I was confused about this. I thought the supplement plan would cover something that Medicare denied and that's not accurate.

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Profile picture for dianeg77 @dianeg77

Just found this chat group. I am not on Medicare and was able to get approved for the Amgen SupportPlus Co-Pay program. I have had 2 treatments so far and not paid a cent. My endocrinologist uses Providence Hospital for the treatments and they enrolled me in the program.

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@dianeg77 Found your post today and wanted to know how your process was with the Amgen Support+ Co-pay Program. I know all bills/providers/etc. are different and might not fit my case. However, in your situation, did the $8K cover all 12 months of your Evenity costs?

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I had Evenity for 12 months.
Original Medicare and uhc supplemental .

Plan F

Paid nothing. I do not know if this would have been different if I had not taken fosomax and forteo first. Never had an Osteoporosis related fracture.
I haven't endocrinologist who is very active when dealing with approvals
I would talk with your doctor and the billing department and get to the bottom of this.

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Profile picture for gravity3 @gravity3

I had Evenity for 12 months.
Original Medicare and uhc supplemental .

Plan F

Paid nothing. I do not know if this would have been different if I had not taken fosomax and forteo first. Never had an Osteoporosis related fracture.
I haven't endocrinologist who is very active when dealing with approvals
I would talk with your doctor and the billing department and get to the bottom of this.

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@gravity3 thanks. I'm 52, so not yet on Medicare.

My endo is still iffy in my book, but she was the only one I could find that accepts my insurance with OP as a specialty. Have already spoken to the billing department. However, what wasn't made clear to me is what happens once the $8K Amgen program maximum is reached.

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Profile picture for nermar1 @nermar1

@gravity3 thanks. I'm 52, so not yet on Medicare.

My endo is still iffy in my book, but she was the only one I could find that accepts my insurance with OP as a specialty. Have already spoken to the billing department. However, what wasn't made clear to me is what happens once the $8K Amgen program maximum is reached.

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@nermar1

Time for a sit down with billing?

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