1. < Osteoporosis & Bone Health

Evenity and Medicare - What do plans cover and how much?

Posted by amli65 @amli65, Sep 12, 2022

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

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gravity3 | @gravity3 | Nov 17, 2023
In reply to @dianestanley "I will be getting my 10th shot of Evenity this month. My doctor sends me to..." + (show)
@dianestanley

I will be getting my 10th shot of Evenity this month. My doctor sends me to an oncology office with Baptist Healthcare to get this shot. Medicare, Part B and my Medicare Supp has paid for my shot so far. I could not get this shot if I had to pay for it. I have a burst compression lumbar I fracture, injuring L1 thru L5 along with S12. My fracture has not healed in two years. I could not get surgery due to the Osteoporosis. I am planning on getting surgery as soon as my numbers improve and my spine surgeon plans to do my surgery. My injury has ruined my life. I can now only stand for 4 to 5 minutes at a time. I have to either sit or lie down. I hope to be out of my pain soon. I had the same problem before starting the shot of not knowing if Medicare, Part B and Supplement would pay. I just took the chance knowing that I would have to divorce my husband of 30 years, so that I could get the money for the shots. That is if the insurance would not pay.

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Thanks so much for your reply. I am very sorry that you are going through this and I send you a hug and blessings.

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gravity3 | @gravity3 | Nov 17, 2023
In reply to @windyshores "@gina5009 you took an oral bisphosphonate, which may increase bone density (or maintain) by affecting bone..." + (show)
@windyshores

@gina5009 you took an oral bisphosphonate, which may increase bone density (or maintain) by affecting bone turnover but does not actively build bone. For those of us with more severe osteoporosis or fractures, bisphosphonates are not strong enough and we need either Forteo, Tymlos or Evenity. Then we might take a bisphosphonate to lock in what we gained.

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Can anyone tell me if tymlos is covered completely by Medicare and supplemental or is it the same story as evenity. Thanks

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1 reply
windyshores | @windyshores | Nov 17, 2023
In reply to @gravity3 "Can anyone tell me if tymlos is covered completely by Medicare and supplemental or is it..." + (show)
@gravity3

Can anyone tell me if tymlos is covered completely by Medicare and supplemental or is it the same story as evenity. Thanks

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I got it for free for 18 months via Radius Assist. The last 6 months (I did two years) was covered by my Medicare Advantage plan but I hit the donut hole. I forget but the copay may have been around $200. I don't know what it would be with your plan and in your state.

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susanfalcon52 | @susanfalcon52 | Nov 18, 2023

I had my sixth dose of Evenity last week. My Medicare Part B covered it at 100% because I have it in an infusion center.

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loriec | @loriec | Nov 18, 2023

So far that is the case for me also. Under B and use the infusion center! A deal breaker financially.

I’ve been on for 7 months. So far only reaction is injection site reaction. Red and hard for 2-3 days.

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hardingv | @hardingv | Nov 18, 2023

If you have traditional Medicare (with or without a medigap plan), Tymlos is not covered under Part B. Rather you need a Part D RX plan. (I don't know anything about Medicare Advantage plans.)

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1 reply
susanfalcon52 | @susanfalcon52 | Nov 19, 2023
In reply to @hardingv "If you have traditional Medicare (with or without a medigap plan), Tymlos is not covered under..." + (show)
@hardingv

If you have traditional Medicare (with or without a medigap plan), Tymlos is not covered under Part B. Rather you need a Part D RX plan. (I don't know anything about Medicare Advantage plans.)

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We are still in Open Enrollment- until December 7. Now is the time to call 1-800-Med-ICAR and shop for a Part D plan. They can tell you which ones cover Tymlos or whatever you are interested in.

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kristie2 | @kristie2 | Nov 19, 2023
In reply to @susanfalcon52 "I had my sixth dose of Evenity last week. My Medicare Part B covered it at..." + (show)
@susanfalcon52

I had my sixth dose of Evenity last week. My Medicare Part B covered it at 100% because I have it in an infusion center.

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Susan ,
I can’t remember if you told us if you have the advantage plan ? My insurance rejected the infusion center and I give my own injections. I live in Nevada and all states are different I guess . I was paying $560. Per shot and my recent went down to $340 .

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1 reply
susanfalcon52 | @susanfalcon52 | Nov 20, 2023
In reply to @kristie2 "Susan , I can’t remember if you told us if you have the advantage plan ?..." + (show)
@kristie2

Susan ,
I can’t remember if you told us if you have the advantage plan ? My insurance rejected the infusion center and I give my own injections. I live in Nevada and all states are different I guess . I was paying $560. Per shot and my recent went down to $340 .

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Kristie2,
I’m not on an Advantage plan. I’m on traditional Medicare. Part B pays for Evenity because I have it in infusion center.

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1 reply
kristie2 | @kristie2 | Nov 20, 2023
In reply to @susanfalcon52 "Kristie2, I’m not on an Advantage plan. I’m on traditional Medicare. Part B pays for Evenity..." + (show)
@susanfalcon52

Kristie2,
I’m not on an Advantage plan. I’m on traditional Medicare. Part B pays for Evenity because I have it in infusion center.

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Thanks

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