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Medicare B coverage of Evenity

Osteoporosis & Bone Health | Last Active: Jul 20 7:31am | Replies (97)

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@colleenyoung

@amli65, ummm, I was going to suggest calling Medicare to find out, but it looks like you did that already. I'm hoping members like @cireland @gailb @artscaping @csday @suemer might have some knowledge and Evenity and coverage and costs.

Have you found out anything in the meantime?

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Replies to "@amli65, ummm, I was going to suggest calling Medicare to find out, but it looks like..."

Yes I did call Medicare. The doctors office said they couldn’t tell me, however they did give me a CPT code J3111, which Medicare said only means injections of Evenity not the assignment cost.
Any suggestions on how to find out Medicare assignment costs for medications.
Thank you

I am getting Evenity monthly now. Today I’ll receive my 8th set of injections. I chose Evenity because the other option would have cost me out of pocket $20k for the year. I didn’t look up the cost but it is negligible. The injections are not fun and I have to get my lab work done in advance to check my calcium levels to ensure that I can get them. I got Prolia for 5 years before this. I can’t know, of course, how these are working but I seem to be fine. I hike in the hilly woods nearby and lead an active life without fear. So, I think It’s a good choice.

I am on Evenity. I had the same problem as you when I had first checked on this drug. Everywhere I had called: No one knew how much I would be paying. I believe that my doctor had to get approval for this drug and it had to be given at an oncologists office. My doctor's office told me that they could not give me the shot in their office that it had to be done in another facility. I also believe the requirements for this shot was that you had to have a prior broken bone especially in your back. I have a Burst Compression Lumbar I Fracture and then I found out that I had Osteoporosis. I was a No. 1 candidate for another break. I have regular Medicare, Med B, a Medicare Supplement, and RX insurance. I took a chance and do not have to pay anything. But you are correct, no one could give me any estimate on the cost of this medicine. Evenity is making me stronger, I can feel it. I hope to be able to get the back surgery this year that my surgeon said he hesitated to do due to my Osteoporosis. I will be getting my 6th shot and have had no problems.