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Evenity and Medicare - What do plans cover and how much?

Osteoporosis & Bone Health | Last Active: Dec 4 8:56am | Replies (129)
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@windyshores

@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.

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baguette | @baguette | Jan 11, 2023

Thanks for sharing the experience on Tymlos.

I am on traditional Medicare and none of the Plan Ds cover Evenity. Which makes sense because as you note it is administered in a doctor's office. So Medicare Part B would have been the logical place for it to be covered. The Medicare supervisor's comment about applying for a formulary exception with the Plan D company made no sense to me.

I will look into Tymlos.

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