Does Medicare Cover Evista?

In this article...
  • Evista is a moderately priced medication used to treat and prevent osteoporosis. Learn whether Medicare covers Evista, including coverage restrictions.

Osteoporosis is one of the most concerning potential effects of going through menopause, so your doctor may prescribe medication to reduce your risk. Evista is a moderately priced drug, so you may worry about how to afford your treatment long-term. Below, you can find out whether Medicare covers Evista and learn about out-of-pocket costs and coverage restrictions. 

What Is Evista?

Evista is a branded type of raloxifene hydrochloride. This medication is a selective estrogen receptor modulator (SERM) used to treat and prevent menopause-related osteoporosis (brittle bones). It may also reduce the risk of invasive breast cancer after menopause.

You'll usually need to take a single 60-milligram tablet once per day, although your doctor may tailor your dosage to your individual requirements. Your healthcare provider may also recommend taking calcium and vitamin D supplements alongside Evista. 

Evista is associated with an elevated risk of blood clots, so you should tell your doctor if you have a history of clots before taking the medication. It can also increase the likelihood of stroke if you have an increased risk of having a heart attack. Other side effects of Evista may include the following:

  • Leg cramps
  • Hot flashes
  • Flu symptoms
  • Headache
  • Edema (fluid retention)

Does Medicare Cover Evista?

Original Medicare doesn't typically cover prescription drugs unless your healthcare provider administers them directly in a hospital or clinic. Therefore, it's unlikely to cover self-administered drugs, such as Evista and other raloxifene medications. 

However, you can purchase supplemental prescription drug coverage (Medicare Part D) from an approved private provider. All Medicare Part D policies cover raloxifene medications, although which version varies by provider. Some Part D plans may cover Evista and other branded drugs, while others may restrict coverage to generic raloxifene. 

You can consult your Medicare Part D formulary to find out which raloxifene medications your plan covers. Evista and similar alternatives typically fall under Tier 2 of the list of covered drugs. If your plan excludes Evista, consider asking your healthcare provider to recommend a covered option.

How Much Will I Pay for Evista With Medicare Part D?

Some Medicare Part D plans don't impose deductibles and cover prescriptions immediately after purchase, although they're usually significantly more expensive than policies with deductibles. If your plan has a deductible, you'll need to spend at least that amount on your medication before coverage kicks in. Medicare Part D insurers cannot set deductibles higher than $480 in 2022 and $505 in 2023. 

You're usually responsible for paying for Evista out-of-pocket until you satisfy the deductible. The average retail cost for Evista is roughly $468.43 for 90 tablets at 60 milligrams each, although prices fluctuate between pharmacies. Where you live can also affect the cost of prescription medications. 

After paying the deductible, your insurer will cover the cost of your prescriptions, minus a nominal co-pay. Some Medicare Part D plans don't charge co-pays for Evista, but you should expect to pay around $4 or less each time you receive coverage. 

Does Medicare Impose Coverage Restrictions for Evista?

Many Medicare Part D plans offer unrestricted coverage for Evista or a similar alternative, so your insurer is unlikely to limit how much medication you can receive from your pharmacy. Furthermore, you won't usually need prior authorization from your healthcare provider to access Medicare coverage for Evista.

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