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Financial discussions/tips concerning expensive treatment

Osteoporosis & Bone Health | Last Active: Feb 14 6:46pm | Replies (64)
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@hopefullibrarian

Update: Unfortunately, my insurance company approved the prior authorization that my doctor submitted. I know it sounds strange, but now, because they approved it, even though my income is below the 300% of the federal poverty level, I'll have to pay my policy's max-out-of-pocket cost for Evenity. I need to make a quick decision on what to do within the next two weeks in order to get a full 12 months of treatment before the insurance clock resets again on Jan. 1st.
I'm waiting for a reply from my endocrinologist about my recent BTM results, because Evenity may not even be the best route for me to take. I certainly don't want to lay out all that money, which has to come from my savings, if there's a better option for me.

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Replies to "Update: Unfortunately, my insurance company approved the prior authorization that my doctor submitted. I know it..."
rjd | @rjd | Jan 18 3:09pm

Is it possible that between the submission of the prior authorization request in 2023 and the approval in 2024 is that your insurer has made coverage changes and now covers the Evenity?

Could your insurance also have changed coverage of any other med you were interested in before deciding to go on Evenity?

You do not say what insurance you have as someone under 65. Is it employer provided insurance or Obama-care?

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hopefullibrarian | @hopefullibrarian | Jan 19 6:32pm

I just found out about another Amgen program thanks to a post by @dianeg77 in the "Evenity Cost" thread. https://connect.mayoclinic.org/comment/999636/
It's the Amgen Support+ Co-pay Program. It's like other co-pay assistance programs where you're given a card with a benefit value that you can use towards your co-pay or co-insurance. With Evenity, the benefit amount is $8000 and you get 3 years to use it.
I enrolled, and got the card details straight away. I've scheduled my first injection after conferring with three specialists who all agree that it's the best treatment for me at this time.

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