Anyone taken Evenity (romosozumab) for Osteoporosis?

@windyshores When my Mayo Clinic endocrinologist prescribed Evenity we talked about where I could get the injections. He informed me that this particular could not be administered at my doctor's office. I know, it sounds odd, but I found out the same from my primary care physician. The infusion center at medical center where I get the injections also administers Evenity to other patients.

On the Evenity website, there are numerous mentions of the injections being given at a doctor's office. Maybe some doctors choose to allow an infusion center to manage the administration. I am fairly sure the fragility clinic I consulted would give the injections in an office setting.

This entire picture is crazy. First thing, it seems to me you need to find out how your insurance processed the claim. Was is processed under Part B or Part D. Look carefully at your Explanation of Benefits and then talk with your insurer again.....ask to be transferred to someone who you can understand.

What are your deductibles? Do you have a deductible for your health plan (would include Part B benefits) and if so, what is it? You likely have a deductible for Part D, often referred to as the drug plan. What is it?

And how much of your deductible had you met when your Evenity claim was processed. Could this first Evenity payment include a very large deductible that might not be part of subsequent payment obligations.

Every Advantage plan seems to have slight differences making it very difficult to compare apples to apples when we discuss things like this on Connect.

IF you still cannot make heads or tails about how your claim was processed, consider getting help understanding how the claim was handled and what to expect next about your responsibility.

You might get this type of help from either your State Health Insurance Program https://www.shiphelp.org/ or from the Medicare Rights Center https://www.medicarerights.org/about.

By the way, who is your insurer? Do you know whether you received prior approval for the Evenity? Are your medical providers 'in-network' or 'out of network?'

Doctor’s office at UNC-Chapel Hill, part of the hospital system. But I have also had Reclast at the infusion center there and they paid the same.

sbcher,
Traditional Medicare does cover Evenity. Because the injections are given in an infusion center, they are covered.
Medicare Advantage plans have different rules and I can’t address those.

Thanks. I'm in Moore county.

I get mine at my endocrinologists office

@rjd Thank you! I really appreciate your advice and the links! I just feel like there is some horrible mistake being made. I printed out the chat with the $20 copay quote and on Monday, I will be making more calls. I have been very happy with my plan until now, this is my 3rd year o this plan. I have United Healthcare Advantage plan, Even though I did not need prior auth, I did get that, too! My providers are all in network. I do not have a deductible, either.

@susanfalcon52 policies of Medicare Advantage are not relevant since it is Medicare Part B that covers Evenity given in a doctor's office or infusion center. People with Medicare Advantage are covered by Part B for Evenity, not their private plans. I pay 20%.

It is doubtful whether Medicare covers Evenity BECAUSE injections are give in an infusion center. Windy' injections are Medicare covered and I understand her to say that her injection is given in her doctor's office.