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Medicare B coverage of Evenity
Osteoporosis & Bone Health | Last Active: Nov 20, 2023 | Replies (64)Comment receiving replies
I followed up on the discussion, and this is the information I received as I understand it:
Medicare Part B does NOT cover Evenity. If there is no cost assignment, it means it is not covered.
A formulary exception has to be filed with your Plan D. This even if the drug is considered a medical expense by commercial policies. That is what a Medicare supervisor told me.
Amgen says it has special assistance for people who have commercial insurance, not Medicare. If you are on Medicare and think your income may qualify you for financial assistance, you can contact the Patient Access Network or the Healthwell Foundation Amgen gave me the names of both of these organizations.
If anyone has found out different information on the issue of Evenity, please share! The other injectable is Forteo. Does anyone have experience with that one? It is a daily injectable, and has a generic, so instead of costing thousands of dollars a month it costs hundreds a month.
Replies to "I followed up on the discussion, and this is the information I received as I understand..."
Medicare Part B DOES cover Evenity because it is administered in the doctors office! I know because I’m getting Evenity injections now with minimal costs or hassle. Interesting how misinformation is spread from allegedly reliable sources.
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@baguette Tymlos is also an injectable and I chose that over Forteo because the dose is adjustable, and I started low and ramped up to minimize side effects.
I talked with Amgen when considering Evenity and was told it was Part B because it is injected in the doctor's office. Unlike Forteo and Tymlos there is no patient assistance program but as you said they can refer to a foundation or two, but at certain times of year the foundations have no funds for this.
I have a Medicare Advantage Plan and Evenity was very expensive for me without help. I qualified for the Tymlos patient assistance (Radius Assist) and have gotten it for free for 18 months.