Evenity and cost

As with all medications, the cost of Evenity can vary. Factors that may affect the price you’ll pay include:

• your treatment plan
• your insurance coverage
• the cost of the visit to your healthcare professional to receive doses of Evenity
• whether Evenity has a savings program (see the “Financial and insurance assistance” section below)

To find out what the cost of Evenity will be for you, talk with your doctor or insurance provider.

Insurance considerations

Below is information you may want to consider if you have insurance and receive Evenity.

Prior authorization. If you have insurance, your insurance company may require prior authorization before it covers Evenity. This means the company and your doctor will discuss Evenity in regard to your treatment. The insurance company will then determine whether to cover the medication. If a drug requires prior authorization but you start treatment without the prior approval, you could pay the full cost of the medication. You can ask your insurance company whether Evenity requires prior authorization.

Type of insurance coverage. Evenity is given by your doctor or another healthcare professional. If you have insurance, the price of your Evenity doses may be billed through your medical coverage instead of the prescription drug portion of your insurance plan. This depends on your specific insurance plan and where you receive your Evenity doses, such as at your doctor’s office, an infusion clinic, or a hospital. If you have questions about this process, contact your doctor or your insurance provider.

Here are answers to some frequently asked questions about drug cost and Evenity.

How does the cost of Evenity injection compare with the cost of Prolia?

The cost of Evenity injection compared with Prolia depends on certain factors. Similar to Evenity, Prolia is a brand-name drug used to treat osteoporosis. One factor is whether you have insurance and how your specific plan covers brand-name drugs. Other factors include the cost of your healthcare visit to receive Evenity or Prolia injections.

If you have insurance coverage, ask your plan provider how much you’ll pay for each drug. If you don’t have insurance, it may be helpful to talk with your doctor. They can help you find ways to save on the cost of Evenity. For more information, see the “Financial and insurance assistance” section below.

Is Evenity covered by Medicare?

Evenity may be covered by Medicare. Whether Medicare covers this medication depends on your specific plan because each plan has different coverage levels. For example, you’ll make a doctor’s visit to receive your Evenity injections. And Medicare Part B may cover the cost of these doctor’s visits.

To find out whether your Medicare plan will cover your Evenity injections, contact your plan provider. You can also visit the drug manufacturer’s website for information about paying for Evenity. To learn more about Medicare, see the “Next steps” section below.

Evenity contains the active drug romosozumab-aqqg,* and it’s available only as a brand-name biologic drug. It doesn’t come in a biosimilar version. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Also, biosimilars tend to cost less than brand-name medications.

* The reason “-aqqg” appears at the end of the drug’s name is to show that the drug is distinct from similar medications that may be created in the future.

WHY ARE COSTS DIFFERENT FOR BIOLOGIC DRUGS VS. BIOSIMILAR DRUGS?

Biologic drugs can be expensive because of the research needed to test their safety and effectiveness. The manufacturer of a biologic drug can sell it for up to 12 years. When the biologic drug’s patent expires, multiple manufacturers can create biosimilar versions. This marketplace competition may lead to lower costs for biosimilars. Also, because biosimilars are very similar to biologic drugs, they don’t require the same costly testing.

If you need financial support to pay for Evenity, or if you need help understanding your insurance coverage, help is available. For example:

• If you have insurance, your cost for Evenity may be covered by the Amgen SupportPlus Co-Pay Program. For more information and to find out if you’re eligible for support, call 866-264-2778 or visit the program website.
• If you don’t have insurance coverage, you may be eligible for the Amgen Safety Net Foundation. To learn more and find out if you’re eligible, visit the foundation’s website.
• Some websites provide details about drug assistance programs, ways to make the most of your insurance coverage, and links to savings cards and other services. Two such websites are:
  • Medicine Assistance Tool
  • NeedyMeds

To learn more about saving money on prescriptions with or without insurance, check out this article.

Now that you’ve learned about cost and Evenity, you may still have some questions. Talk with your doctor or pharmacist, who can provide personalized guidance about cost issues related to Evenity. But if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you would pay for Evenity.

Here are some other resources you may find helpful:

• Medicare drug coverage. To learn about Medicare coverage for drugs, see these articles about Medicare prescription drug plans, drug coupons and Medicare, and the Medicare drug list.
• More details. For details about other aspects of Evenity, refer to this article.
• Side effects. For details about Evenity’s side effects, see this article. You can also look at the Evenity prescribing information.
• Drug comparison. Find out how Evenity compares with Prolia and Forteo.
• Information about your condition. For more information about your condition, see our list of osteoporosis articles.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.