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News Article: Cost and Insurance Coverage of Evenity
The cost of Evenity, a biologic drug used to treat osteoporosis, can vary significantly based on factors such as treatment plan, insurance coverage, healthcare professional visit costs, the presence of a savings program, and the pharmacy used.
Evenity is classified as a high-cost specialty medication and requires provider-administered injections, which contribute to its price. At GoodRx, the average monthly cost for Evenity is around $1,836 for a 30-day supply. Treatment duration is typically limited to one year.
Insurance coverage plays a crucial role in determining the out-of-pocket costs for Evenity. In many cases, Evenity is covered under the medical benefit, not the standard prescription drug benefit, which can impact patient costs depending on the insurance plan.
Cost-sharing under Medicare Advantage plans may require patients to pay a percentage (e.g., 33%) for specialty drugs like Evenity after deductible, contributing substantially to cost. Prior authorization and step therapy criteria, such as having tried injectable bisphosphonates or showing contraindications to them, can also affect access and, indirectly, cost.
Comparatively, Prolia, another osteoporosis treatment, is administered less frequently and may be less expensive per treatment period due to less frequent dosing. However, the exact comparative prices depend on insurance and geographic location. Both drugs have step therapy requirements involving prior use or contraindications to bisphosphonates for coverage approval.
For those without insurance, financial and insurance assistance is available for Evenity, including the Amgen SupportPlus Co-Pay Program, which may provide financial assistance to help reduce costs for people with insurance. Other resources for people without insurance can be found on the Medicine Assistance Tool and NeedyMeds websites.
To find out the cost of Evenity and whether your Medicare plan will cover it, it's essential to contact your plan provider. Evenity may be billed through medical coverage rather than prescription drug benefits, depending on your insurance plan and where you receive your Evenity doses. The cost comparison between Evenity and Prolia depends on specific factors such as insurance coverage and the cost of healthcare visits for injections.
In summary, Evenity generally involves higher costs due to monthly administration, specialty drug designation, and provider administration fees, whereas Prolia might be less costly on a per-treatment basis because of less frequent dosing. Coverage factors such as medical vs. pharmacy benefit and insurer-specific prior authorization significantly affect the actual out-of-pocket costs for both drugs.
- In the case of Evenity, health insurances have a significant impact on out-of-pocket costs, with some patients under Medicare Advantage plans required to pay a percentage of the cost after meeting their deductible.
- For individuals without health insurance, therapies and treatments like Evenity may still be accessible through financial and insurance assistance programs, such as the Amgen SupportPlus Co-Pay Program.
- Since Evenity is classified as a high-cost specialty medication, its price is influenced by factors like healthcare providers, medical-conditions management, and the medicare status of the patient.
- Businesses in the health-and-wellness sector should consider patient cost and insurance coverage when offering treatments like Evenity, given the wide variations in prices due to factors such as savings programs and pharmacy usage.
- The comparative costs between Evenity and other osteoporosis treatments, like Prolia, are influenced by multiple factors including insurance coverage, frequency of dosing, and the geographic location of the patient.
