Evenity and Medicare drug coverage

Posted by lbtw @lbtw, Jun 2 2:43pm

I don’t know if any of you can offer a suggestion — but thought I’d give this group a try. I just started Evenity this past week and it is covered by my current insurance. In August I will be on Medicare and I’m trying to find a drug plan - part D - as I research them — none cover Evenity — with a 17,000+$ cost. Any suggestions. Thanks in advance

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

Okay — that helps me understand. Thank you

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@normahorn

Evenity falls under Part B.

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another perfect answer from njhornung

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@lbtw I have Traditional Medicare. Evenity is covered under Part B however I have to go to a clinic with an Infusion Center to get my injections. In order to Evenity to be covered I could not get the injections at my PCP (primary care provider) office.

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This is a guess re PCP Offices Amgen says Medicare covers it in an office setting. However, this is the guess part, PCP's may not want to deal with the administrative aspects so default to using infusion centers. Most likely you can continue receiving Evenity where you are now receiving it.

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I am on traditional Medicare. I recently had my 12th injections of Evenity. Because I had them at an infusion center, they were covered under Part B.
100% covered. When I receive the EOB from Medicare explaining what they paid for what and how much, the Evenity bill is heart stopping.
$5,000+. So, in the past year Medicare has paid more than $60,000 for my Evenity treatment. I am very grateful, but still know that Big Pharma is a monster.

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@naturegirl5

@lbtw I have Traditional Medicare. Evenity is covered under Part B however I have to go to a clinic with an Infusion Center to get my injections. In order to Evenity to be covered I could not get the injections at my PCP (primary care provider) office.

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it’s my understanding that a PCP is not expected to have adequate expertise to prescribe Eventitiy….and that it is customarily prescribed by an endocrinologist or rheumatologist

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lbtw @lbtw I'm on traditional Medicare and Evenity is paid for under Part B not Part D. I have Medicare supplemental also so I pay nothing. I get my shots in the doctors office. I do not believe there is any requirement for an infusion center. My doc is a rheumatologist. I do not know but I would guess that Evenity could be given in a primary care docs office if they were into osteoporosis enough to want to do that. Also I am a male and some say Medicare won't approve for men. Well they did for me, with some effort. I think there is a problem in that Medicare does not pre-approve osteoporosis meds. Some types of drug you can get pre-approval, as in a written document I guess but that is not the case for osteoporosis. Anyway I eventually got approved but not I think ahead of the submittal for payment after the first shot. Some of this was not visible to me but that's the best I can piece it together. They are paying for it I'm certain of that.

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