Insurance company is denying Evenity

Posted by rudysmom @rudysmom, 1 day ago

I just got a call from my Dr stating my insurance company BCBS is denying Evenity. They want me to do Prolia first. I told the person who called me that Prolia is the one drug I didn’t want to do. That there is research showing if I do that first the Evenity won’t be as effective, also that Prolia rebounds quickly. She agreed with me, but this is what insurance company wants done first. I said it’s ridiculous they get to dictate my healthcare. Again she agreed. She told me to think about it and call them back.

I was diagnosed back in February with a -2.7 in spine. Hips are still in osteopenia, don’t remember those numbers. I decided in May to go on Evenity and it’s been a battle ever since. A couple years ago I tried Fosomax when I was still in osteopenia and had reaction of severe pain in my right hip, so I stopped taking it after 3 weeks. I’m afraid if I can’t tolerate Fosomax I’m not going to tolerate Prolia. Not sure what to do at this point. 😣

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

Evenity was also denied by my insurance company. Fortunately, my doctor has a department that appeals all of those types of decisions. We won on appeal. Do not give up. Fight back. Ask your doctor to send in the appeal. That is not something you can do, but need your doctor to do.

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Profile picture for summera1 @summera1

If you are not on Medicare, check to see if your plan has a specialty pharmacy. Mine does and Tymlos costs $0. However, your numbers are not that bad. Tymlos, for me, has side effects. And, after Tymlos needs to followed up by more drugs. If I were you, I would go with weight lifting, hopping, calcium from food, d3/k2, before osteoporosis drugs. I would also do BIOIDENTICAL estrogen/progesterone topical cream on thigh, if the doctors say you are able. I cannot do HRT now, but I do weight lifting, hopping, calcium from food, d3/k2. I wish I had a DEXA sooner. I am -3.9

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@summera1
My Tymlos through Medicare/Humana advantage plan and cvs specialty is 0$ after I pay the first $2900 each year. They allow you to spread that out if you need to.

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