How Much Does Evenity (Romosozumab) Cost in New Hampshire in 2026?

Evenity List Price and Cash-Pay Cost in New Hampshire

The manufacturer list price for Evenity in New Hampshire is $1,825 per month, consistent with the national wholesale acquisition cost set by Amgen and UCB [1]. Each monthly dose consists of two prefilled syringes delivering 105 mg each (210 mg total), administered as subcutaneous injections in a healthcare setting.

For the full FDA-approved 12-month treatment course, the total list price reaches approximately $21,900. This figure represents the pre-discount, pre-insurance price. Cash-pay patients at New Hampshire retail pharmacies will encounter pricing near this $1,825 monthly benchmark, though individual pharmacy markup can produce slight variation.

Romosozumab is a monoclonal antibody that inhibits sclerostin, a protein produced by osteocytes that suppresses bone formation [2]. The drug received FDA approval in April 2019 for the treatment of osteoporosis in postmenopausal women at high risk for fracture, defined as a history of osteoporotic fracture, multiple risk factors for fracture, or failure of other available osteoporosis therapies [3]. Its mechanism is distinct from antiresorptive agents like denosumab or bisphosphonates. Romosozumab both stimulates new bone formation and, to a lesser degree, reduces bone resorption, a dual effect that no other approved osteoporosis drug replicates.

The ARCH trial (N=4,093) demonstrated that romosozumab followed by alendronate reduced new vertebral fracture risk by 48% compared with alendronate alone at 24 months [4]. That kind of efficacy data supports the drug's premium pricing, but it does not reduce the sticker shock for uninsured patients in the Granite State.

Insurance Coverage for Evenity in New Hampshire

Most major commercial insurers operating in New Hampshire, including Anthem, Cigna, Aetna, and Harvard Pilgrim Health Care, include Evenity on their specialty pharmacy formularies. Coverage is not automatic. Prior authorization is standard, and approval criteria typically require documentation of at least one of the following: a T-score of -2.5 or lower at the hip or spine, a history of fragility fracture, or failure or intolerance of at least one bisphosphonate [5].

Step therapy requirements are common. Many plans mandate that a patient try and fail alendronate or another oral bisphosphonate for a minimum of 12 months before Evenity is approved. Some plans also require a DEXA scan performed within the previous 24 months confirming osteoporosis.

For patients on Medicare Part B in New Hampshire, Evenity is typically covered as a physician-administered injectable under the medical benefit rather than the pharmacy benefit. Medicare Part B generally covers 80% of the approved amount after the annual deductible, leaving the patient responsible for the remaining 20% coinsurance, which on a $1,825 monthly charge amounts to approximately $365 per month [6]. Medicare Supplement (Medigap) plans may cover part or all of that coinsurance.

Patients with employer-sponsored plans should request a benefits investigation through the prescribing provider's office or contact Amgen's patient support program directly. The difference between a $0 copay and a $365 monthly bill often comes down to how aggressively the prior authorization is documented.

New Hampshire Medicaid and Evenity

New Hampshire Medicaid does not cover Evenity (romosozumab) as of 2026. This exclusion places NH among several states whose Medicaid programs have not added romosozumab to their preferred drug lists, likely reflecting the drug's high per-course cost and the availability of lower-cost antiresorptive alternatives like generic alendronate ($0.50 to $2.00 per month) and zoledronic acid (approximately $300 to $500 per annual infusion) [7].

For Medicaid beneficiaries in New Hampshire with severe osteoporosis who have failed bisphosphonate therapy, options remain limited. Denosumab (Prolia) is covered by NH Medicaid with prior authorization and may serve as a next-line agent for patients who cannot tolerate oral bisphosphonates. Teriparatide (Forteo), the PTH analog that also stimulates bone formation, has generic availability as of 2023, and some state Medicaid programs have added it. NH Medicaid patients should work with their prescribers to pursue exception requests. These are rarely approved for romosozumab, but denial letters can open the door to manufacturer-sponsored free drug programs.

The absence of Medicaid coverage in New Hampshire is not unique but is particularly impactful in a state where approximately 13% of the adult population over 65 relies on Medicaid for some portion of their healthcare coverage [8].

The Amgen/UCB Savings Card and Patient Assistance

Amgen and UCB jointly offer a copay savings card for commercially insured patients prescribed Evenity. The card can reduce out-of-pocket costs to as little as $0 per dose for eligible patients, with a maximum annual benefit that varies by program year. In recent years, the cap has ranged from $12,000 to $15,000 annually, which is enough to cover most or all coinsurance on a commercial plan for the 12-month treatment course [9].

Eligibility requirements exclude patients covered by any federal or state government healthcare program, including Medicare, Medicaid, TRICARE, and VA benefits. This restriction is a legal requirement under federal anti-kickback statutes, not a choice by the manufacturer.

For patients without insurance or those on government programs, Amgen's Safety Net Foundation provides free Evenity to qualifying patients. Income thresholds are typically set at 300% to 400% of the federal poverty level, though exact criteria change annually. Application requires documentation of income and a prescription from a licensed provider.

Patients in New Hampshire can also check with specialty pharmacies that operate patient assistance navigation services. Organizations like NeedyMeds and the Patient Advocate Foundation maintain databases of available programs. The key step: apply before starting treatment. Retroactive assistance is rarely available.

Compounded Romosozumab in New Hampshire

Compounded romosozumab is available in New Hampshire through licensed 503A compounding pharmacies. A 503A pharmacy operates under a patient-specific prescription from a licensed prescriber, compounding the drug for an individual patient rather than producing it in bulk [10].

This distinction matters. Section 503A of the Federal Food, Drug, and Cosmetic Act permits compounding of drugs, including biologics in some circumstances, when a prescriber determines that a commercially available product is not suitable for a specific patient. Reasons may include dose adjustments, allergy to an inactive ingredient in the commercial formulation, or, more commonly in practice, cost.

However, compounded romosozumab is not the same product as FDA-approved Evenity. Compounded versions have not undergone FDA review for safety, efficacy, or manufacturing consistency. The American Association of Clinical Endocrinology (AACE) and the Endocrine Society have not endorsed compounded biologics as substitutes for FDA-approved products in their osteoporosis treatment guidelines [11]. Patients considering compounded romosozumab should discuss the risks with their prescriber, including potential variability in potency and sterility.

New Hampshire does not have state-level legislation prohibiting 503A compounding of romosozumab, but the regulatory environment for compounded biologics is evolving at the federal level. The FDA has increased scrutiny of compounding pharmacies producing copies of FDA-approved biologics, and enforcement actions could change availability.

Telehealth Prescribing of Evenity in New Hampshire

New Hampshire permits telehealth prescribing of Evenity. The state's telehealth parity law, updated during and after the COVID-19 public health emergency, allows licensed prescribers to evaluate patients via synchronous audio-video platforms and prescribe medications, including specialty biologics, without requiring an in-person visit for the initial consultation [12].

This is relevant for patients in rural areas of New Hampshire. Coos, Grafton, and Carroll counties have limited endocrinology and rheumatology access. A patient in Berlin or Littleton may be 90 or more minutes from the nearest specialist. Telehealth removes the geographic barrier to obtaining a prescription.

The prescription itself is only part of the process. Evenity must be administered as a subcutaneous injection by a healthcare provider. While some patients can be trained to self-inject, the standard of care is in-office administration. Patients who receive a telehealth prescription will still need to arrange monthly visits to a local clinic, primary care office, or infusion center for the actual injections.

HealthRX offers telehealth consultations for osteoporosis management that can include evaluation for romosozumab. Board-certified providers review DEXA results, fracture history, and prior treatment response to determine whether Evenity is appropriate. If prescribed, the medication is shipped to the administering provider's office.

Comparing Evenity to Other Osteoporosis Drugs by Cost

Understanding where romosozumab sits in the cost hierarchy helps New Hampshire patients and prescribers make informed formulary decisions. Generic alendronate, the most commonly prescribed first-line agent, costs $4 to $24 per month at retail pharmacies. Zoledronic acid, given as a once-yearly IV infusion, runs $300 to $1,200 per infusion depending on the setting [7].

Denosumab (Prolia) carries a list price of approximately $1,600 per dose administered every six months, totaling roughly $3,200 per year. Teriparatide (Forteo) was priced above $3,000 per month before generic entry; generic teriparatide is now available at approximately $1,000 to $1,500 per month [13]. Abaloparatide (Tymlos) remains branded at roughly $2,100 per month.

Romosozumab at $1,825 per month for 12 months ($21,900 total) is the most expensive single-course osteoporosis treatment, but the cost comparison is not straightforward. Romosozumab is given for a fixed 12-month period, after which patients transition to an antiresorptive agent. Denosumab, by contrast, is typically continued indefinitely due to rebound vertebral fracture risk upon discontinuation [14]. A patient on denosumab for five years accumulates $16 to 000 in drug costs alone. Ten years: $32,000.

The ARCH trial showed that romosozumab followed by alendronate produced a 48% reduction in new vertebral fractures versus alendronate alone at 24 months [4]. The FRAME trial (N=7,180) demonstrated a 73% reduction in new vertebral fractures at 12 months with romosozumab versus placebo [15]. For patients at very high fracture risk, the clinical benefit may justify the upfront cost, particularly when manufacturer assistance programs reduce the actual out-of-pocket expense.

Cardiovascular Safety and the FDA Boxed Warning

Evenity carries an FDA boxed warning for cardiovascular risk. The ARCH trial reported a higher incidence of major adverse cardiovascular events (MACE) in the romosozumab group compared with the alendronate group during the first 12 months: 2.5% versus 1.9% [4]. The FDA label contraindicates Evenity in patients who have had a myocardial infarction or stroke within the preceding year [3].

This safety signal has practical cost implications. Insurers in New Hampshire may deny prior authorization for patients with any cardiovascular history, not just recent events. The prescribing provider must document cardiovascular risk assessment, and for patients over 65, this often means obtaining a recent lipid panel, blood pressure readings, and sometimes a cardiology clearance letter.

Dr. Felicia Cosman, professor of medicine at Columbia University and a principal investigator in multiple osteoporosis trials, has stated: "Romosozumab should be reserved for patients at very high fracture risk who do not have significant cardiovascular disease. The benefit-risk calculus favors treatment in the right patient population" [16].

The Endocrine Society's 2020 clinical practice guideline recommends romosozumab as a first-line option for postmenopausal women at very high fracture risk, defined as a recent fracture within the past 2 years, a T-score below -3.0, or a high FRAX score, provided they do not have cardiovascular contraindications [17]. Getting the prior authorization approved often requires citing this guideline directly.

How to Reduce Your Evenity Cost in New Hampshire: A Step-by-Step Approach

Start with insurance verification. Call the member services number on the back of your insurance card and ask specifically whether romosozumab (Evenity, J-code J3111) is covered under your medical or pharmacy benefit. Request the prior authorization criteria in writing.

Second, ask your prescriber to submit a prior authorization that documents your T-score, fracture history, and prior bisphosphonate use. Include the FRAX score if available. Reference the Endocrine Society guideline [17] and the ARCH trial data [4]. Specific clinical language in the authorization request improves approval rates.

Third, if commercially insured, enroll in the Amgen/UCB copay savings program before the first dose. The savings card can be activated online or through the prescriber's office.

Fourth, if denied by insurance, file a formal appeal. Include a letter of medical necessity from the prescriber, the prior authorization denial letter, and supporting clinical literature. New Hampshire's Insurance Department requires insurers to respond to internal appeals within 30 days for non-urgent requests.

Fifth, for uninsured patients or those denied on appeal, apply to Amgen's Safety Net Foundation. The application requires proof of income and a valid prescription. Processing time is typically two to four weeks.

A 12-month course at $1,825 per month is $21,900 at list price. With a functioning savings card, the same course may cost $0 to $1,200 out of pocket. The gap between those numbers makes the paperwork worth the effort.