← Return to Evenity….stopped after the first set of injections…

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@naturegirl5

Since this Discussion started with Evenity I thought I'd answer the questions that have come up regarding Medicare. I have Traditional Medicare and do not have a Medicare Advantage Plan.
Evenity must be administered at an infusion center or hospital/clinic. For that reason, Evenity can be billed as Medicare Part B (outpatient such as going to your doctor's office) and not as Part D that you get from the pharmacy and that you administer to yourself. I don't know how it works with other medications such as Prolia or Tymlos.

It can be really difficult to figure what is covered, what your co-pay will be, and what is not covered. It's best to call or write your insurance company. I do know that if Medicare has approved coverage of a medication that all Medicare Advantage programs and Part D prescription plans must include the medication in their coverage. However, the costs will differ between plans. That's where it can get confusing.

Just an FYI. I was introduced to GoodRX by a pharmacist. I always check GoodRX when I get a new prescription because sometimes their co-pay is less than my Part D prescription plan. It's so crazy.

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Replies to "Since this Discussion started with Evenity I thought I'd answer the questions that have come up..."

Thanks Helen.

From my research & for those on Original Medicare (not Medicare Advantage):
Fosamax (or generic Alendronate) is covered by Part D drug plan
Forteo, Teriparatide, Tymlos, Prolia are covered by Part D
Evenity, Reclast are covered by Part B

For all meds, you need to verify cost with your insurance carrier. Your out-of-pocket costs can be very different from carrier to carrier.

Best place to start is Medicare.gov.

There are places to seek financial assistance:
LillyCares for Forteo
Radius Assist for Tymlos
RX Advocate for overall
GoodRx (mentioned above)
Also, some states offer plans for state residents e.g., ArrayRXcard.com for CT
Some of these plans do not cover government funded plans e.g., Medicare. Some of these plans have income limits. Unfortunately, you really need to do the research for your circumstances.

I hope this helps everyone.