Does Medicare Cover Boniva?

There are many medications available that treat osteoporosis. One of which is Boniva.

Boniva is the brand-name for the prescription drug that contains the active drug, ibandronate.

This drug is used to treat osteoporosis after menopause. It comes in two forms – Boniva tablets and Boniva injections.

A common question many people have about this drug is, “Does Medicare cover Boniva?” In this article, we do our best to answer that question in clear, plain English. You will also find the average costs of Boniva and other helpful info.

The short answer is yes; Medicare will cover the cost of Boniva. But not 100% of the time. As is often the case with Medicare, certain conditions must be met in order for Medicare to pick up the tab. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) provides coverage for Boniva. Original Medicare provides coverage for injectable medications for treating osteoporosis. So that means, they are likely to provide coverage for injectable Boniva. Coverage for injectable osteoporosis drug (Boniva) is provided by Medicare Part B.

Aside from providing coverage for injectable osteoporosis medications, Original Medicare may also help cover the cost of a home health nurse to administer the injectable osteoporosis drug (ie. Boniva). But only under these conditions:

You’re a woman
You are eligible for Medicare Part B and you meet the criteria for Medicare home health services
You have a bone fracture and your healthcare provider confirms the bone fracture was caused by, or is related to, postmenopausal osteoporosis
Your healthcare provider certifies that you are unable to administer the injectable osteoporosis drug (Boniva) and your family members or your caregivers are unable or unwilling to give you the injectable osteoporosis drug (Boniva)

If you are eligible, Original Medicare will also fully cover the costs of the home health nurse visit to administer the injection for you.

Once approved, Medicare Part B will pay for 80 percent of the costs of your injectable osteoporosis drug. You will pay for the remaining 20 percent.

Part C

Medicare Advantage plans (Medicare Part C) also provide coverage for Boniva. They cover everything Original Medicare covers as well as offer some additional benefits. However, exactly what they cover and how much the out-of-pocket costs are will vary depending on the specifics of your plan.

Part D

Medicare Part D also provides coverage for Boniva. 99 percent of Medicare Part C and Part D plans provide coverage for Boniva.

Most Medicare plans restrict how much Boniva you can get at a time. If you need get any more than that, Medicare may not cover it.

In this case, you can wait until a certain amount of time has passed before refilling. Or, if you really need more than the permitted amount of Boniva in a single purchase, you can contact your plan provider and ask for an exception.

Bottom Line

So, bottom line here is Original Medicare will likely cover the injectable form of Boniva for those who need it. But likely won’t cover the tablet form. However, most Part C and D plans will cover the tablets.

How Much Does Boniva Cost?

The average cost of 1 dose (3 pack tablets) of 150 mg Boniva is about $340. For the injectable version, it costs about $560 for a 3 ml supply. These prices are for those who do not have insurance.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.