Vincent Thrasher
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If you’re one of the millions of Americans suffering from osteoporosis, you may be wondering if Medicare covers Evenity, a new treatment that has been shown to increase bone density. The good news is that Medicare does cover Evenity, but there are some important things you need to know before you start treatment.
In this article, we’ll take a closer look at what Evenity is, how it works, and what you can expect from treatment. We’ll also explain how Medicare covers Evenity and what you need to do to ensure you get the most out of your coverage. So, if you’re ready to learn more about this groundbreaking new treatment, read on!
Yes, Medicare Part B and Part D may cover Evenity for eligible beneficiaries. Evenity is a medication used to treat osteoporosis in postmenopausal women who are at high risk of fractures. Medicare Part B covers medically necessary outpatient services, including certain injectable drugs, while Part D covers prescription drugs. However, coverage and costs may vary depending on the specific Medicare plan and the beneficiary’s individual circumstances. It is important to check with your Medicare plan provider for more information on coverage and costs.
Understanding Evenity and Medicare Coverage
If you have osteoporosis, you know it can be a debilitating condition that impacts your quality of life. Evenity is a medication that can help treat osteoporosis by increasing bone mass and reducing the risk of fractures. But if you’re on Medicare, you might be wondering if the cost of Evenity is covered. Here’s what you need to know.
What is Evenity?
Evenity is a medication used to treat osteoporosis in postmenopausal women at high risk of fracture. It’s a monoclonal antibody that works by blocking a protein that inhibits bone formation. This increases bone density and reduces the risk of fractures. Evenity is typically administered as a subcutaneous injection every month for a total of 12 doses.
Does Medicare Cover Evenity?
The short answer is yes, Medicare does cover Evenity. However, coverage may vary depending on your plan and individual circumstances. Evenity is covered under Medicare Part B, which covers medically necessary outpatient services. This includes injected or infused medications like Evenity that are administered by a healthcare provider.
To receive coverage for Evenity, you’ll need to meet certain criteria. Your doctor will need to demonstrate that you have a medical need for the medication and that it’s medically necessary for your condition. You’ll also need to have a Medicare-approved diagnosis of osteoporosis and be at high risk for fractures.
What are the Benefits of Evenity?
Evenity has been shown to increase bone mass and reduce the risk of fractures in postmenopausal women with osteoporosis. In clinical trials, Evenity was found to be more effective at reducing the risk of fractures than other osteoporosis medications. It’s also a convenient treatment option, as it only requires a once-monthly injection.
Evenity vs Other Osteoporosis Medications
There are several other medications used to treat osteoporosis, including bisphosphonates, denosumab, and teriparatide. Each medication works differently and has its own set of benefits and drawbacks. Evenity is a relatively new medication and has not been directly compared to other osteoporosis medications in clinical trials. However, Evenity has been found to be more effective at reducing the risk of fractures than placebo.
What is the Cost of Evenity?
The cost of Evenity varies depending on your insurance coverage and individual circumstances. Evenity can be an expensive medication, with each monthly dose costing around $1,825. However, most Medicare beneficiaries will only be responsible for paying a portion of the cost, depending on their plan. If you have a Medigap plan, it may cover some or all of the cost of Evenity.
What is the Coverage Gap?
If you’re on a Medicare Part D plan that includes prescription drug coverage, you might be familiar with the “coverage gap” or “donut hole.” This refers to a period of time when you’re responsible for paying a larger portion of the cost of your medications. If you reach the coverage gap while taking Evenity, you’ll be responsible for paying a larger portion of the cost until you reach the catastrophic coverage phase.
How Can I Get Evenity Covered by Medicare?
To get Evenity covered by Medicare, you’ll need to work with your doctor and insurance provider. Your doctor will need to provide documentation that demonstrates the medical necessity of Evenity for your condition. Your insurance provider will also need to verify that Evenity is covered under your plan and determine your out-of-pocket costs.
Conclusion
Evenity is a promising treatment option for postmenopausal women with osteoporosis at high risk of fracture. While it can be an expensive medication, Medicare does cover the cost of Evenity for those who meet certain criteria. If you’re considering Evenity as a treatment option, talk to your doctor and insurance provider about your options.
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Frequently Asked Questions
Medicare is a federal health insurance program that provides coverage for millions of Americans. Many people wonder if Medicare covers Evenity, a prescription drug used to treat osteoporosis. Here are some frequently asked questions and answers about Medicare coverage for Evenity.
Question 1: What is Evenity?
Evenity is a prescription medication used to treat osteoporosis in postmenopausal women who are at high risk for fracture. It is given as an injection once a month and works by increasing bone formation and decreasing bone loss. Evenity is typically used in conjunction with other medications, such as calcium and vitamin D supplements.
While Evenity is a relatively new medication, it has been shown to be effective in reducing the risk of fractures in postmenopausal women with osteoporosis. However, not all insurance plans, including Medicare, cover the cost of Evenity.
Question 2: Does Medicare cover Evenity?
Medicare Part D, which covers prescription drugs, does cover Evenity. However, coverage may vary depending on the specific Medicare plan you have. Some plans may require prior authorization before covering the cost of Evenity, and others may require you to try other medications before approving coverage for Evenity.
If you have a Medicare Advantage plan, coverage for Evenity may be different than traditional Medicare. It is important to check with your specific Medicare plan to see what medications are covered and what costs you may be responsible for.
Question 3: How much does Evenity cost with Medicare?
The cost of Evenity with Medicare coverage can vary depending on your specific plan. Medicare Part D plans typically have a monthly premium and a deductible, and you may be responsible for a copayment or coinsurance for each prescription. The actual cost of Evenity will depend on your plan’s specific pricing structure.
If you are concerned about the cost of Evenity, you can speak with your healthcare provider or pharmacist about potential cost-saving strategies, such as using a generic medication or applying for financial assistance programs.
Question 4: What if Evenity is not covered by my Medicare plan?
If Evenity is not covered by your Medicare plan, there may be alternative medications that are covered. Your healthcare provider can work with you to find a medication that is appropriate for your condition and covered by your insurance plan.
If there are no alternative medications that are covered, you can also speak with your healthcare provider or pharmacist about potential cost-saving strategies, such as using a generic medication or applying for financial assistance programs.
Question 5: How do I find out if Evenity is covered by my Medicare plan?
You can find out if Evenity is covered by your Medicare plan by contacting your plan directly or by visiting the Medicare website. You can also speak with your healthcare provider or pharmacist, who may be able to provide information about coverage and potential cost-saving strategies.
It is important to review your Medicare plan’s coverage each year during the open enrollment period to ensure that it still meets your healthcare needs and covers the medications you need.
In conclusion, the answer to the question “Does Medicare Cover Evenity?” is not a straightforward one. While Medicare Part B covers most bone density scans, Evenity is a newer medication that may not be covered under traditional Medicare plans. However, Medicare Advantage plans may provide coverage for Evenity.
It’s important to note that coverage for Evenity may vary by state and by plan. It’s always a good idea to check with your Medicare plan and your healthcare provider to see if Evenity is covered and what your out-of-pocket costs may be.
Ultimately, if Evenity is not covered under your Medicare plan, there may be other treatment options available. Your healthcare provider can work with you to determine the best course of treatment for your specific needs and health conditions.
Vincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior insurance, encompassing Medicare, Medigap, long-term care insurance, life insurance, and dental, vision, and hearing insurance. Vincent's unwavering passion for guiding seniors through the intricate insurance landscape and crafting customized solutions to address their individual needs has earned Over65InsuranceOptions an esteemed reputation as a dependable ally for seniors nationwide.
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