Is Evenity Covered By Medicare?

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...Read more

Introduction:

Osteoporosis is a common condition that affects millions of people worldwide. It is characterized by weak and brittle bones that are more prone to fractures, and it can be a serious health concern, especially for older adults. Evenity is a medication that has been approved by the FDA for the treatment of osteoporosis, but many people are wondering if it is covered by Medicare.

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If you or a loved one has been diagnosed with osteoporosis, you may be wondering if Evenity is covered by Medicare. Unfortunately, the answer to this question is not straightforward. While Medicare does cover some medications for the treatment of osteoporosis, the coverage for Evenity may vary depending on your specific plan.

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In this article, we will explore the coverage options for Evenity under Medicare and what you can do to ensure that you are getting the best possible coverage for your medication. We will also discuss some alternative treatment options for osteoporosis and how they may be covered under Medicare. So, if you are looking for answers about Evenity and Medicare coverage, keep reading to learn more.

Is Evenity Covered by Medicare?

Is Evenity Covered by Medicare?

If you are considering treatment with Evenity, a medication used for the treatment of osteoporosis, you may be wondering if it is covered by Medicare. Medicare typically covers medically necessary treatments, but coverage can vary depending on the medication and the specific plan.

Understanding Evenity

Evenity is a medication used to treat osteoporosis in postmenopausal women at high risk of fracture. The medication works by increasing bone formation and decreasing bone loss. Evenity is typically administered as a subcutaneous injection once a month.

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How Evenity Works

Evenity is a monoclonal antibody that targets a protein called sclerostin, which inhibits bone formation. By blocking sclerostin, Evenity increases bone formation and decreases bone loss, leading to improved bone density and strength.

Side Effects of Evenity

Like any medication, Evenity can cause side effects. Common side effects include joint pain, headache, and injection site reactions. More serious side effects, such as hypersensitivity reactions, have also been reported.

Medicare Coverage for Evenity

Medicare coverage for Evenity can vary depending on the specific plan and the reason for treatment. In general, Medicare Part B may cover Evenity for the treatment of osteoporosis in postmenopausal women who are at high risk of fracture.

Medicare Part B Coverage

Medicare Part B covers medically necessary services and supplies, including certain medications administered in a doctor’s office or outpatient setting. If Evenity is administered in a doctor’s office or outpatient setting, it may be covered under Medicare Part B.

Medicare Part D Coverage

Medicare Part D covers prescription drugs, including medications used to treat osteoporosis. If Evenity is prescribed as a self-administered injection, it may be covered under Medicare Part D.

Costs of Evenity with Medicare

The cost of Evenity with Medicare can vary depending on the specific plan and the way the medication is administered. It is important to check with your Medicare plan to understand the costs associated with Evenity.

Medicare Part B Costs

If Evenity is covered under Medicare Part B, you may be responsible for paying a portion of the cost, including the deductible and coinsurance. The cost-sharing amount can vary depending on the specific plan.

Medicare Part D Costs

If Evenity is covered under Medicare Part D, you may be responsible for paying a portion of the cost, including the deductible, copayment, or coinsurance. The cost-sharing amount can vary depending on the specific plan.

Alternatives to Evenity

There are other medications available for the treatment of osteoporosis that may be covered under Medicare. These medications work in different ways and may have different side effects and costs.

Bisphosphonates

Bisphosphonates are a class of medications used to treat osteoporosis by slowing bone loss. Examples of bisphosphonates include alendronate and risedronate. These medications are typically taken orally.

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Denosumab

Denosumab is a medication used to treat osteoporosis by inhibiting bone resorption. It is administered as a subcutaneous injection every six months.

Teriparatide

Teriparatide is a medication used to treat osteoporosis by stimulating bone formation. It is administered as a subcutaneous injection once a day.

Conclusion

If you are considering Evenity for the treatment of osteoporosis, it is important to understand your Medicare coverage and the costs associated with the medication. Be sure to check with your Medicare plan to determine coverage and costs. Additionally, be sure to discuss alternative treatment options with your healthcare provider to determine the best course of treatment for you.

Frequently Asked Questions:

1. What is Evenity and how does it work?

Evenity is a prescription medication used to treat osteoporosis in postmenopausal women who are at high risk for bone fractures. It works by increasing bone formation and decreasing bone breakdown, which helps strengthen bones and reduce the risk of fractures.

Evenity is given as an injection under the skin once a month for 12 months. After the first 12 months, your healthcare provider may switch you to a different medication to help maintain your bone density.

2. Is Evenity covered by Medicare?

Yes, Evenity is covered by Medicare Part B for eligible patients. However, coverage may vary depending on your specific plan and the stage of your osteoporosis. Your healthcare provider can help you determine if Evenity is the right treatment option for you and if it is covered by your Medicare plan.

3. How much does Evenity cost under Medicare?

The cost of Evenity under Medicare can vary depending on your specific plan and the stage of your osteoporosis. However, most Medicare Part B plans cover Evenity at 80% of the cost, leaving the patient responsible for the remaining 20%.

If you have a Medicare Advantage plan, the cost of Evenity may be different depending on your plan’s specific coverage and co-pay requirements. Your healthcare provider can help you understand your plan’s coverage and costs.

4. Are there any restrictions on who can receive Evenity under Medicare?

Yes, there are some restrictions on who can receive Evenity under Medicare. To be eligible for coverage, patients must have a diagnosis of osteoporosis and be at high risk for bone fractures. Additionally, patients must have a bone mineral density test that shows they have low bone mass or osteoporosis.

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Your healthcare provider can help determine if you meet the eligibility criteria for Evenity under Medicare and if it is the right treatment option for you.

5. Are there any side effects of Evenity?

Like all medications, Evenity can cause side effects. The most common side effects include joint pain, headache, and swelling at the injection site. In rare cases, Evenity can cause serious side effects such as allergic reactions or low calcium levels in the blood.

If you experience any side effects while taking Evenity, you should contact your healthcare provider right away. They can help determine if the side effects are serious and if you should continue taking Evenity.

In conclusion, Evenity is a newly approved medication that is used to treat osteoporosis. Despite its effectiveness, it can be quite expensive for patients who are on a limited budget. Many people are wondering if Evenity is covered by Medicare. Unfortunately, the answer is not straightforward.

While Medicare does cover some osteoporosis medications, Evenity is not currently included on the list of covered drugs. This means that patients who require Evenity may need to pay out of pocket for their treatment. However, it’s important to note that there are other options available, such as alternative medications or financial assistance programs.

Overall, it’s essential for patients to speak with their healthcare providers and insurance companies to determine the best course of action for their unique situation. While Evenity may not be covered by Medicare, there are still options available for those who need it.

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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