Medicare Advantage Coverage of Evenity

Posted by bellagila @bellagila, May 21, 2023

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.

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

John, Volunteer Mentor | @johnbishop | May 21, 2023

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

njhornung | @normahorn | May 21, 2023

I thought Evenity fell under Part B.

sarahstuart Sarah Stuart McIlvain | @sarahstuart | May 21, 2023

As a fellow New Yorker (Syracuse), you should know that everything is political. So start with a call to the Health Department and find out who can answer your questions. Ask your questions. If you don't get the answers you want, then go to you local politician and lay out your case. Good Luck!