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

I get my Evenity from an Oncology office. When I see the payment from Medicare, Medicare Part B and my Med Supp, it shows $23,000. I don't know why there are so many prices for this drug. That number is not wrong as I will have my 10th shot next week. All paperwork through Medicare has been this number. I thought it was a mistake.

When I investigated the cost of Evenity, I found that it was approximately $2200-2300 per month. I live in Southern California and I don’t know if the cost of medications varies from state to state.

I was wondering why everyone is taking this expensive medication. I took Ibandornate for many years with good success. It is a simple pill, taken once a month. I believe it is covered under your medicare drug coverage.
Gina5009

I live in NYC and the city is trying to push its retirees into the Aetna Medicare Advantage PPO City of New York plan, effective Sept 1, 2023. I have severe osteoporosis and am worried that if I start Evenity now, under regular Medicare with a supplement, ( where it will be covered), if I switch to the Advantage plan in Sept., that either the Evenity will be discontinued or it will be extremely expensive. Any thoughts or experiences with this? Thank you.

I live in NYC and the city is trying to push its retirees into the Aetna Medicare Advantage PPO City of New York plan, effective Sept 1, 2023. I have severe osteoporosis and am worried that if I start Evenity now, under regular Medicare with a supplement, ( where it will be covered), if I switch to the Advantage plan in Sept., that either the Evenity will be discontinued or it will be extremely expensive. Any thoughts or experiences with this? Thank you.

I live in NYC and the city is trying to push its retirees into the Aetna Medicare Advantage PPO City of New York plan, effective Sept 1, 2023. I have severe osteoporosis and am worried that if I start Evenity now, under regular Medicare with a supplement, ( where it will be covered), if I switch to the Advantage plan in Sept., that either the Evenity will be discontinued or it will be extremely expensive. Any thoughts or experiences with this? Thank you.

Hi @bellagila, I know it's frustrating when your health plan insurance gets switched. I went through a similar change this year and found out that the best thing you can do is call the insurance company and talk to them about your concern. I found a frequently asked questions document on your upcoming plan that might be helpful. Here are two of the FAQs listed in the document linked below.

"How do I know if my drug is covered?

The formulary (list of covered drugs) is Comprehensive+, an open formulary which means that all Medicare Part D drugs are covered. To check if your drugs are covered or estimate the cost of the drugs you are taking, visit our website at CONY.AetnaMedicare.com

I’m currently taking a drug that requires a prior authorization (PA) every year. How do I know
if the drug is covered and how much is the cost?

All Medicare Part D drugs are covered under the Comprehensive+ formulary. However, if the drug you are taking requires a prior authorization, the plan will cover up to a 30-day supply in the first 90 days of when the plan starts as a transition of care fill. After your first fill, we will notify you and your doctor to submit a prior authorization. If you need assistance or have questions, call the number on your prescription drug member ID card."
--- City of New York Aetna Medicare Advantage PPO plan: https://www.nyc.gov/assets/olr/downloads/pdf/health/aetna-ma-docs/cny-0029-faqs-print-single-pages-final.pdf

I thought Evenity fell under Part B.