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

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.

Good morning @amli65, I am happy to meet you on Connect. Thanks for the introduction @colleenyoung. This is a tough issue, particularly because Evenity is a relatively new product. You may need to do the following:
1. Make sure a pre-approval request has been made by your doctor
2. Find out if Amgen, the company that produces the product, has a preferred "specialty pharmacy."
Here is the phone # for Amgen 800-772-6436. Ask to speak to someone in the patient support group....they are medical professionals, mostly RNs who can
help you.
3. Make sure that Evenity is on the Medicare formulary. If not, ask for a formulary exception.
4. Ask if there is any program or organization that will help you with the copay.
5. If you are on Social Security (SS), you may have to apply for low-income assistance from SS. If you qualify for assistance then that is helpful. If you are denied
by SS then that information can be used to support your application for other assistance from Amgen or a recommended assistance program.
6. Be patient, and follow up frequently. Your doctor may also be asked to submit approval documents clarifying your need for the medication.
7. Make sure the renewal date requirement covers your one year of Evenity. If not, then find out how and when to renew.

Good luck to you. Evenity appears to be a good choice because it both builds and protects the new bone.
I am not an expert at this process. My daughter actually took over for me since she works in a dental surgery environment and knows how to handle insurance situations. However, I am here to help wherever I can.

May you have happiness and the causes of happiness.
Chris

This answer is al wrong! EVENITY IS COVERED UNDER MEDICARE PART B BECAUSE IT IS ADMINISTERED IN THE DOCTOR’S OFFICE! I am getting these injections now and it was NO hassle and costs almost nothing for me. Some of the advisors out there are reps of the Medicare Advantage private insurance industry that I do not trust. Be careful who you listen to.

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.

@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?

Wow! I spent 45 minutes on the phone with Medicare to get the information that I shared here. How disheartening to hear that the information was wrong. I guess it's like talking to the IRS. They will answer your questions but not guarantee that their information is correct. I too originally thought Medicare would cover Evenity because it is a medical expense (i.e., administered in the doctor's office) but was unwilling to order it because Medicare wouldn't tell me the cost. That is how I got the information that there was no cost listed because there is no coverage.

How bizarre. Thanks for sharing your experience.

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.

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.

Thanks for sharing your experience. Glad it worked out that you didn't have to pay anything after the leap of faith agreeing to the drug without knowing cost.

I do not have a broken bone yet so sounds like I can't get Evenity anyway. I preferred a monthly injection instead of a daily that I did myself. I don't understand the logic of waiting until someone who has been DX'd with severe osteoporosis breaks a bone before gaining access to a drug known to help greatly in addressing the disease.

Good luck with your treatment. That's great that you can feel the drug making you stronger.