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Struggling with making an osteoporosis treatment decision
Osteoporosis & Bone Health | Last Active: Jun 4 11:43pm | Replies (661)Comment receiving replies
I have traditional Medicare with a Part D drug plan.
The Part D drug plan denied Evenity coverage. I appealed the decision twice and it was still denied. Can you explain if your doctor orders the Evenity and bills it as part of the treatment plan to Medicare Part B?
I am currently on Forteo with some positive results but have been on it over two years. It was authorized for a third year for some people. I have no side effects. The Part D drug plan picks up most of the costs after the deductible is met which still leaves me with covering alot of the costs. Was on Bisphosphates for 15 years with increasingly worse bone density.
Any advice re getting Evenity covered would be much appreciated.
Nancy
Replies to "I have traditional Medicare with a Part D drug plan. The Part D drug plan denied..."
Seems so crazy that there are so many variations in how treatments are covered and paid for. I also have traditional Medicare and a Part D drug plan plus a Medicare supplemental insurance plan. Since my Evenity shots are administered at a hospital infusion center, not a doctor's office, once per month, Medicare negotiates and pays a certain lessor portion of the total cost, and then my supplemental insurance plan pays the remaining 20% of that negotiated cost. The Part D insurance doesn't come into play at all.
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If you are getting the shots at an infusion center or a hospital, Part B pays for it. Part B has been paying mine for 4 months. The only way Medicare Part B would deny it would be if they thought your osteoporosis wasn't bad enough.