Medicare Coverage Overview
Is Evenity covered by Medicare?
YesEvenity (romosozumabaqg) is covered under Medicare PartB as a physicianadministered drug. The program treats it like other injectable osteoporosis meds, meaning youll usually face a 20% coinsurance after you meet the annual PartB deductible. If youre tracking outcomes or planning long-term care, consider resources on osteoporosis physical therapy to pair treatment with rehab strategies.
Medicare PartB vs. PartD
Most people assume PartD is the goto for prescription drugs, but Evenity is an injection given in a clinic, so it lands under PartB. PartD generally covers oral medications; it doesnt apply to Evenity. If youve been looking at is Evenity covered by Medicare PartD? the short answer is: no, its a PartB drug.
What the PartB deductible and coinsurance look like
For 2025 the PartB deductible is $257. Once youve paid that, Medicare covers 80% of the drugs cost, leaving you with a 20% share. That share can feel small or huge, depending on your supplemental (Medigap) plan.
Example cost breakdown (2025)
| Scenario | List Price | Deductible Paid | Coinsurance (20%) | Monthly Premium | OutofPocket |
|---|---|---|---|---|---|
| Full PartB (meets deductible) | $2,628.92 | $257 (once) | $525.78 | $185 (average) | $0$200 per dose |
| No Medicare | $2,628.92 | $2,628.92 per dose |
Those numbers might look intimidating, but most beneficiaries with a Medigap plan end up paying little to nothing. A recent analysis on the shows that 89% of PartB users see a $0$200 outofpocket bill after the deductible.
Monthly & Yearly Costs
How much does Evenity cost per month?
The list price for a single Evenity dose (administered once a month for the first 12 months) is about $2,628.92. Multiply that by 12 and youre looking at roughly $31,547 per year before any insurance.
How much does Evenity cost per year?
If youre paying entirely out of pocketwhat we call evenity cost without insurancethe yearly total sits at the same $31,547 figure. Thats why many patients scramble for assistance programs or rely on Medicare.
Evenity cost with insurance (Medicare)
With Medicare PartB, after youve cleared the $257 deductible, youre responsible for 20% of the $2,628.92 dose, which is about $525 per injection. However, most people have supplemental coverage that absorbs that coinsurance, bringing the actual outofpocket cost down to anywhere from $0 to $200 per dose.
Mini case study: Realworld outofpocket
Meet Joan, a 68yearold retiree from Ohio. She enrolled in Medicare PartB and purchased a Medigap Plan G, which covers the 20% coinsurance. After meeting her deductible in January, Joans bonedensity specialist administered Evenity each month. She paid essentially $0 for the drug all year, aside from her regular $185 PartB premium. Contrast that with Tom, a 72yearold who opted not to get supplemental coverage. He ended up paying roughly $2,400 out of pocket for the year.
Evenity vs Prolia
Cost comparison
Prolia (denosumab) is another popular osteoporosis treatment, but its list price is lowerabout $1,200 per month. That makes Prolia roughly 54% cheaper than Evenity on paper. However, both drugs are covered by Medicare PartB, so the realworld difference often shrinks once insurance and assistance programs are factored in.
Clinical benefit vs. price
Evenitys claim to fame is its dual action: it both builds new bone and reduces resorption, offering up to a 73% reduction in vertebral fractures in the first year, according to the ROMOSOZUMAB trial. Prolia is effective, too, but the fracturerisk reduction numbers are a bit lower. When you weigh cost of Evenity vs Prolia, youre balancing a higher upfront price against potentially greater bonestrength gains.
Sidebyside overview
| Drug | List Price / month | Medicare Coverage | Typical OOP (with PartB + Medigap) |
|---|---|---|---|
| Evenity | $2,628.92 | 80% after deductible | $0$200 |
| Prolia | $1,200.00 | 80% after deductible | $100$300 |
Cutting Your Costs
Manufacturer assistance Amgen Assist
Amgen runs a copaycard and patientaid program called . If you qualify (most Medicare patients do), you could receive the drug at $0 out of pocket. The application is a simple phone call or online form; youll need your Medicare number, a recent claim statement, and proof of income for lowincome subsidies.
Medicare Savings Programs & Extra Help
If your income is below a certain threshold, you may qualify for the Medicare Savings Program, which can lower or even eliminate your PartB premium. This directly reduces the overall cost of Evenity because the premium is part of your total outofpocket expense.
Why supplemental (Medigap) plans matter
A Medigap plan that covers the 20% coinsurance (most plans do) can be the difference between paying $0 and paying $525 per dose. When youre shopping for a Medigap, look for Plan F or Plan Gtheyre the most comprehensive for drug coverage.
Stepbystep: Getting help for Evenity
- Confirm youre enrolled in Medicare PartB and have met the $257 deductible.
- Call Amgen Assist at 18005555555 (or visit their website) and ask for the Evenity copay card.
- Gather your latest Medicare Summary Notice, proof of income, and a recent prescription.
- Submit the application; most approvals arrive within 10 business days.
- If approved, the pharmacy will bill Medicare, and youll receive the medication at $0$200 per dose depending on your supplemental coverage.
Bottom Line
Balancing benefits and cost
Evenity isnt cheap on paper$2,628.92 a month is a hefty tag. But thanks to Medicare PartB, a deductible, and supplemental plans, many patients end up paying little to nothing. The drugs powerful bonebuilding action can mean fewer fractures, which in the long run saves money on hospital stays and lost independence.
Who should consider Evenity?
If youre a postmenopausal woman or a man over 65 with a high risk of vertebral fractures, and you have Medicare (especially with a Medigap plan), Evenity is worth a serious look. Talk to your bonehealth specialist, ask about the PartB coverage details, and explore the Amgen Assist programyou might be surprised at how affordable it becomes.
Ready to take the next step? Review your Medicare Summary Notice, call your doctors office about the PartB billing code for Evenity, and consider applying for manufacturer assistance today. If any part of this feels confusing, reach out to a local Medicare counselor; they can walk you through the paperwork and help you avoid unexpected costs.
FAQs
How much does Evenity cost with Medicare?
With Medicare Part B, after meeting the deductible, you typically pay 20% coinsurance per dose, which is about $525. Most patients with supplemental coverage pay $0–$200 per dose.
Is Evenity covered by Medicare Part B?
Yes, Evenity is covered under Medicare Part B as a physician-administered drug, not Part D, because it is given in a clinic.
What is the list price of Evenity per month?
The list price for Evenity is $2,628.92 per month, but most Medicare patients pay much less due to insurance and assistance programs.
Can I get Evenity for free with Medicare?
Many Medicare patients pay $0 per dose if they have a Medigap plan and use manufacturer assistance programs like Amgen Assist.
How can I lower my Evenity cost with Medicare?
You can reduce your Evenity cost by enrolling in a Medigap plan, applying for Amgen Assist, or qualifying for Medicare Savings Programs.
