Does Medicare cover osteoporosis drugs?

Which osteoporosis drugs does Medicare cover?

Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) cover certain injectable osteoporosis drugs, and visits by a home health nurse to give you the injections. For people with osteoporosis, these drugs may prevent further bone loss and help strengthen weak bones. Medicare's home health benefit lists injectable osteoporosis drugs for women who meet certain criteria among the services it covers.

Who qualifies for Medicare coverage of osteoporosis injections?

You qualify if you're a woman with osteoporosis who meets all of these conditions:

• You meet the criteria for Medicare home health services, which include needing part-time or intermittent skilled services and being homebound.
• You have a bone fracture that a doctor or other health care provider certifies is related to postmenopausal osteoporosis.
• A health care provider certifies that you can't give yourself the injection or learn how to, and your family members or caregivers are unable or unwilling to give you the injection.

What does homebound mean for this Medicare benefit?

Homebound means you meet both of these conditions: leaving home isn't recommended because of your condition, or you have trouble leaving home without help (like a cane, wheelchair, walker or crutches, special transportation, or help from another person) because of an illness or injury; and you're normally unable to leave home, and leaving takes a lot of effort. You may still leave home for medical treatment or for short, infrequent absences for non-medical reasons, like attending religious services. Before you can get home health services, a doctor or other provider must see you in person, confirm you need home health care and order it, and a Medicare-certified home health agency must provide it. See Does Medicare cover home health care?.

What do I pay for osteoporosis drugs under Medicare?

In most cases, after you meet the Part B deductible ($283 in 2026), you pay up to 20% of the Medicare-approved amount for covered Part B prescription drugs. Your coinsurance can change depending on the drug's price: you might pay a lower coinsurance for certain Part B-covered drugs whose prices have gone up faster than the rate of inflation, and the specific drugs change every quarter. You pay nothing for the home health nurse visit to inject the drug.

What if my osteoporosis drug isn't covered by Part A or Part B?

Medicare drug coverage (Part D) covers drugs that Part B doesn't cover, so check your plan's drug list (formulary) to find out which outpatient drugs it covers. Each Medicare drug plan has its own formulary. If you or your prescriber believes none of the drugs on your plan's list will work for your condition, you can ask the plan for an exception, with a supporting statement from your prescriber. See Does Medicare cover prescription drugs?.

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, and most include Medicare drug coverage (Part D); rules and costs vary by plan. Medigap policies generally don't cover prescription drugs.