Does Medicare Cover Boniva?

Does Medicare Cover Boniva?

Medicare does cover Boniva for some people. The following groups are eligible for Medicare Part D drug insurance coverage:

Medicare beneficiaries who are enrolled in Part A or Part B of Medicare, and also enrolled in Medicare Part D.

People who are enrolled in Medicare Part D, but not enrolled in Part A or Part B of Medicare.

The following groups of people are eligible for Medicare Part D insurance, but may not be eligible for Boniva:

Medicare beneficiaries who are enrolled in Part A only of Medicare.

People who are enrolled in Medicare Part B of Medicare.

Medicare beneficiaries who are enrolled in Medicare Advantage Plans.

Medicare beneficiaries who do not have Medicare Part D, but have Medicare Prescription Drug Coverage through an employer group health plan.

Medicare beneficiaries who do not have Medicare Part D, but have Medicare Prescription Drug Coverage through a retiree health plan.

What is the Medicare coverage policy for Boniva?

Medicare Part D policies are created and issued by private health insurance companies that Medicare contracts with. Each company decides individually which drugs it will cover and at what tier.

How much does Boniva cost?

Medicare Part D insurance coverage is essentially a discount card. The insurance company pays a portion of the cost of the drug, and the beneficiary pays the balance. The beneficiary's portion is based on the number of “coverage gap” (donut hole) months. In 2011, most people (with some exceptions) will only be in the coverage gap for one or two months. This means that the beneficiary will pay 50% of the cost for the first $310 of the prescription and 25% of the cost for the remaining $148. The beneficiary will only pay a portion of the cost of Boniva until he has spent $4,700 or until the end of 2011, whichever comes first.

What is the coverage gap (donut hole)?

The coverage gap (also called the donut hole) is a temporary limit on most Medicare Part D plans. When a beneficiary reaches the coverage gap, he must pay 100% of the drug costs for the rest of the year. (There is an exception in 2011, during which the beneficiary only has to pay 50% of the cost.) After the beneficiary has paid $4,700 out of his own pocket for covered drugs, his Part D plan will pay 100% of covered drug costs until the end of the calendar year.

How does the coverage gap affect you?

In 2011, most people with Medicare Part D will only enter the coverage gap in one or two months. This means that they will pay 25% of the cost of Boniva until they reach the coverage gap and have to pay 100% of the cost of the drug.

Who qualifies for the Medicare coverage gap discount card?

In 2011, people with Medicare who are enrolled in Medicare Part D can receive the coverage gap discount card when they have spent $2,830 on brand-name drugs and $2,830 on generic drugs, and enter the coverage gap. People with Medicare who are enrolled in Medicare Part D can receive the coverage gap discount card when they have spent $2,830 on brand-name drugs and $2,830 on generic drugs, and enter the coverage gap. People who have a Medicare Advantage Plan may have coverage for their prescriptions paid by their plan and may not be able to get the coverage gap discount card.

Why do I pay a co-pay for brand-name drugs, but not for generic drugs?

The co-pay for brand-name drugs is a discount from the full cost of the drug. The co-pay for generic drugs is just enough to cover the cost of the generic drug. This means the insurance companies are helping you pay for the generic drug, not the brand-name drug.

What are the side effects of Boniva?

The most common side effects of Boniva include, but are not limited to:

Back pain

Gas

Headache

Joint pain

Nausea

Pain in arms or legs

Pain in chest, upper stomach, or back

Period pain

Stomach pain

What should I discuss with my doctor or pharmacist before taking Boniva?

If you have an allergy to Boniva or any other part of this drug.

If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.

If you have any of these health problems: Bone loss problems, blood vessel disease, circulation problems (especially in the hands and feet), decreased bone density, heart disease, or high blood pressure.

If you have had any of these health problems: Liver problems.

If you are taking any of these drugs: Aricept, Cymbalta, Gilenya, or Rebif.

If you are taking any of these drugs: Bortezomib, Colchicine, Everolimus, Immunosuppressants, or Tacrolimus.

If you have used any of these drugs: Abatacept, Adalimumab, Anakinra, Aprepitant, Atorvastatin, Bevacizumab, Cetirizine, Clarithromycin, Crizotinib, Cyclosporine, Dabrafenib, Dasatinib, Deferasirox, Denileukin, Docetaxel, Doxorubicin, Fingolimod, Gefitinib, Imatinib mesylate, Imatinib, Ibritumomab, Ifosfamide, Imipenem-cilastatin, Irinotecan

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