Medicare B coverage of Evenity

Posted by amli65 @amli65, Sep 12 12:26pm

Medicare B coverage info for Evenity. How much do they pay per month for it. Medicare could not answer the question about cost or the assignment they pay per month. Does anyone know?
The amount would help to see if it would be affordable.

Thank you in advance for your input

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

@amli65, ummm, I was going to suggest calling Medicare to find out, but it looks like you did that already. I'm hoping members like @cireland @gailb @artscaping @csday @suemer might have some knowledge and Evenity and coverage and costs.

Have you found out anything in the meantime?

REPLY
@colleenyoung

@amli65, ummm, I was going to suggest calling Medicare to find out, but it looks like you did that already. I'm hoping members like @cireland @gailb @artscaping @csday @suemer might have some knowledge and Evenity and coverage and costs.

Have you found out anything in the meantime?

Jump to this post

Yes I did call Medicare. The doctors office said they couldn’t tell me, however they did give me a CPT code J3111, which Medicare said only means injections of Evenity not the assignment cost.
Any suggestions on how to find out Medicare assignment costs for medications.
Thank you

REPLY

Good morning @amli65, I am happy to meet you on Connect. Thanks for the introduction @colleenyoung. This is a tough issue, particularly because Evenity is a relatively new product. You may need to do the following:
1. Make sure a pre-approval request has been made by your doctor
2. Find out if Amgen, the company that produces the product, has a preferred "specialty pharmacy."
Here is the phone # for Amgen 800-772-6436. Ask to speak to someone in the patient support group….they are medical professionals, mostly RNs who can
help you.
3. Make sure that Evenity is on the Medicare formulary. If not, ask for a formulary exception.
4. Ask if there is any program or organization that will help you with the copay.
5. If you are on Social Security (SS), you may have to apply for low-income assistance from SS. If you qualify for assistance then that is helpful. If you are denied
by SS then that information can be used to support your application for other assistance from Amgen or a recommended assistance program.
6. Be patient, and follow up frequently. Your doctor may also be asked to submit approval documents clarifying your need for the medication.
7. Make sure the renewal date requirement covers your one year of Evenity. If not, then find out how and when to renew.

Good luck to you. Evenity appears to be a good choice because it both builds and protects the new bone.
I am not an expert at this process. My daughter actually took over for me since she works in a dental surgery environment and knows how to handle insurance situations. However, I am here to help wherever I can.

May you have happiness and the causes of happiness.
Chris

REPLY
@artscaping

Good morning @amli65, I am happy to meet you on Connect. Thanks for the introduction @colleenyoung. This is a tough issue, particularly because Evenity is a relatively new product. You may need to do the following:
1. Make sure a pre-approval request has been made by your doctor
2. Find out if Amgen, the company that produces the product, has a preferred "specialty pharmacy."
Here is the phone # for Amgen 800-772-6436. Ask to speak to someone in the patient support group….they are medical professionals, mostly RNs who can
help you.
3. Make sure that Evenity is on the Medicare formulary. If not, ask for a formulary exception.
4. Ask if there is any program or organization that will help you with the copay.
5. If you are on Social Security (SS), you may have to apply for low-income assistance from SS. If you qualify for assistance then that is helpful. If you are denied
by SS then that information can be used to support your application for other assistance from Amgen or a recommended assistance program.
6. Be patient, and follow up frequently. Your doctor may also be asked to submit approval documents clarifying your need for the medication.
7. Make sure the renewal date requirement covers your one year of Evenity. If not, then find out how and when to renew.

Good luck to you. Evenity appears to be a good choice because it both builds and protects the new bone.
I am not an expert at this process. My daughter actually took over for me since she works in a dental surgery environment and knows how to handle insurance situations. However, I am here to help wherever I can.

May you have happiness and the causes of happiness.
Chris

Jump to this post

Thank you for the input. I will try all the suggestions. I find it that the medical world, drug co, insurance co, health care office administrators, & Medicare. They all seem to pass the buck, instead of just giving out the info, good or bad at least people would know to make an informed decision.
Thank you again

REPLY
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