Evenity (Romosozumab) Cost in Washington 2026: Prices, Insurance & Savings

Evenity is the brand name for romosozumab-aqqg, a sclerostin-inhibitor monoclonal antibody made by Amgen and marketed with UCB. The FDA approved it in April 2019 for osteoporosis treatment in postmenopausal women at high risk of fracture. It is not a small-molecule drug, and it is not the same class as bisphosphonates (alendronate, risedronate) or the older anabolic agent teriparatide. This page covers what is stable and verifiable about Evenity's cost structure and coverage rules in Washington, and separates that from figures that change often and were not independently confirmed for this draft.

A note on the numbers below: the specific dollar amounts, prior-authorization timelines, and payer names attributed to Washington in earlier versions of pricing pages like this one are the kind of detail that goes stale within months and that this draft could not independently verify against a current, dated primary source. Where a claim is a stable federal or clinical fact (FDA approval, boxed warning, 12-dose treatment limit), it is presented as fact. Where a claim depends on a specific insurer's formulary, a state Medicaid program's current prior-authorization criteria, or a manufacturer program's current terms, it is flagged as something the reader or a benefits coordinator needs to verify directly before relying on it.

The direct answer

Evenity has no generic or FDA-approved biosimilar as of this writing, so its list price (wholesale acquisition cost, or WAC) is set by the manufacturer and is not something a general reference article can state precisely without checking a current, dated source such as the manufacturer's own pricing disclosures or a pharmacy benefit lookup. What is established is the treatment structure: a fixed 12-monthly-dose course, administered as two 210 mg subcutaneous injections combined per visit, after which patients are expected to transition to an antiresorptive drug (denosumab or a bisphosphonate) to preserve the bone density gained. Washington Apple Health (Medicaid) and most Washington commercial insurers do cover romosozumab for appropriately documented severe osteoporosis, but every plan requires prior authorization, and the specific clinical criteria, processing timelines, and cost-sharing tier differ by payer and change over time.

What is actually stable: FDA approval, dosing, and the boxed warning

These facts come from the FDA-approved product and are not expected to vary by state or by payer:

• Evenity (romosozumab-aqqg) was approved by the FDA in April 2019 for treatment of osteoporosis in postmenopausal women at high risk of fracture, defined as a history of osteoporotic fracture, multiple risk factors for fracture, or failure of other osteoporosis therapies.
• The approved dosing is 210 mg (given as two 105 mg subcutaneous injections) once monthly for 12 months. The FDA label limits the total treatment course to 12 doses; a second course is not part of the approved regimen.
• Evenity carries an FDA boxed warning for cardiovascular risk and is contraindicated in patients who have had a myocardial infarction or stroke within the preceding year. Prescribers are expected to weigh cardiovascular risk factors before starting therapy.
• Verification: the current label and full prescribing information should be confirmed directly with the FDA's drug database or the manufacturer's current prescribing information. Anyone relying on exact contraindication or dosing language for a specific patient should read the current label directly rather than a summary.

What the trial evidence supports, and its limits

Two randomized trials are commonly cited for romosozumab's efficacy: a placebo-controlled trial (often referred to as FRAME) and a head-to-head trial against alendronate in patients at very high fracture risk (often referred to as ARCH). Both trials reported that romosozumab reduced new vertebral fractures compared with the comparator arm over roughly 12 to 24 months, and the ARCH trial also reported a numerically higher rate of adjudicated serious cardiovascular events in the romosozumab arm compared with alendronate during the treatment phase. This cardiovascular signal is the basis for the boxed warning and for the one-year post-MI/stroke contraindication.

This draft is not carrying forward the specific fracture-reduction percentages, event counts, or a cost-per-QALY figure that appeared in an earlier version of this page, because the underlying citation links could not be independently confirmed as pointing to the correct, currently accessible papers. A reader who needs the exact trial numbers for clinical decision-making should pull the primary publications directly from PubMed or the New England Journal of Medicine and confirm the population, timepoint, and effect size before citing them. That verification step matters more here than in most drug articles because the cardiovascular safety signal is the single biggest driver of both the boxed warning and payer prior-authorization criteria.

Does Washington Medicaid (Apple Health) cover Evenity?

Washington Apple Health does cover romosozumab for eligible members, consistent with most state Medicaid programs' treatment of FDA-approved osteoporosis therapies, but coverage is administered through prior authorization and the specific clinical thresholds (T-score cutoffs, required fracture history, required prior bisphosphonate trial, FRAX score thresholds) are set by the Washington Health Care Authority's current preferred drug list and clinical criteria documents, not by this article. Those criteria are revised periodically. A prescriber's office or the pharmacy benefit manager handling the prior authorization is the accurate source for the current requirement, not a generic cost page.

Patients with both Medicare and Medicaid coverage should also know that Medicare Part B, not Part D, generally covers physician-administered biologics like Evenity under the buy-and-bill pathway, with Part B's standard 20% coinsurance structure applying before any Medicaid or supplemental coverage picks up the remainder. General information on Part B drug coverage is available from CMS, though CMS's site does not publish Washington Medicaid-specific criteria.

Commercial insurance in Washington

Most major commercial insurers operating in Washington include romosozumab on a specialty tier and require prior authorization, typically documenting a qualifying T-score, a fracture history, or a very-high-fracture-risk classification consistent with guideline recommendations from professional endocrinology societies addressing postmenopausal osteoporosis. Specialty-tier cost-sharing structures (flat copay versus percentage coinsurance, and where the annual out-of-pocket maximum sits) vary by plan and by whether the plan is fully insured or a self-funded employer plan, which are regulated differently. There is no single answer that applies across all Washington commercial plans. A benefits investigation initiated by the prescriber's office or specialty pharmacy, not a general web page, is the reliable way to learn an individual plan's actual cost-sharing.

The Amgen/UCB savings card

Amgen offers a manufacturer copay assistance program for commercially insured patients prescribed Evenity. As is standard for these programs, it is restricted to patients with private insurance that covers the drug, and it explicitly excludes patients enrolled in federal or state health programs (Medicare, Medicaid, TRICARE, VA), because federal anti-kickback rules prohibit manufacturer copay assistance for those beneficiaries. Beyond that structural framework, the specific dollar cap, per-dose benefit, and annual maximum are terms Amgen sets and can change; this draft is not stating a specific figure because it could not confirm one against a currently dated source. Patients should check the current terms directly on Amgen's Evenity support site or by calling the program before assuming a specific savings amount.

One detail worth raising directly with a benefits coordinator: some pharmacy benefit managers use "copay accumulator" programs that prevent manufacturer card payments from counting toward a patient's deductible or out-of-pocket maximum. If a plan uses an accumulator, a savings card can still reduce the monthly bill but may not reduce the total annual cost-sharing exposure the way a patient expects. This is a real and dated (2024) industry-wide practice documented by pharmacy benefit researchers, and it is worth confirming for any specific plan before relying on the card to cover an entire 12-dose course.

Is compounded romosozumab legal or realistic in Washington?

Federal law (Section 503A of the FD&C Act) allows state-licensed compounding pharmacies to prepare patient-specific prescriptions from FDA-registered bulk drug substances, and Washington's pharmacy licensing framework follows this federal structure. In principle, compounding is legal here.

In practice, romosozumab is a large monoclonal antibody, not a small molecule. Compounding a biologic requires sterile fill-finish capability, cold-chain handling, and potency testing that most retail or even most specialty 503A compounding pharmacies do not have. There is no established, widely available compounded romosozumab market in Washington as of this writing, and claims of "$0" or steeply discounted compounded pricing in some drug-price databases likely reflect the absence of a real listed product rather than genuine low-cost availability. A patient considering any compounded biologic should verify the specific pharmacy's accreditation (for example, through the Pharmacy Compounding Accreditation Board) and should understand that a compounded biologic is not FDA-approved, meaning its safety, sterility, and potency have not been independently verified by the FDA the way the branded product's have.

Telehealth prescribing in Washington

Washington generally permits telehealth evaluation and prescribing for chronic conditions including osteoporosis, and state telehealth parity requirements generally direct insurers to cover telehealth visits comparably to in-person visits. A prescriber can reasonably review DEXA and FRAX results and prescribe Evenity through a telehealth visit. The injections themselves still require either in-clinic administration or self-injection training, and DEXA imaging requires in-person scanning. Readers should confirm current Washington telehealth statute details directly rather than relying on a summary, since telehealth coverage rules are periodically updated by the state legislature and insurance commissioner.

After the 12 doses: why the follow-on drug matters as much as the price

The FDA label limits Evenity to a single 12-dose course. Clinical evidence on romosozumab consistently shows that bone density gains made during treatment are not maintained if a patient stops without transitioning to an antiresorptive drug (denosumab or a bisphosphonate). This has a direct cost implication: the total cost of an osteoporosis treatment plan built around Evenity is the Evenity course plus a second drug's ongoing cost, not the Evenity course alone. Denosumab (Prolia) and generic alendronate are both far less expensive per dose than Evenity, but each has its own insurance approval process, and a gap in that follow-on approval can leave a patient unprotected between the end of Evenity and the start of maintenance therapy. Coordinating that second prior authorization before the 12-dose course ends is a practical step worth confirming with the prescribing office, independent of pricing.

Evidence boundary: what is established versus what needs verification

Established: FDA approval for postmenopausal women at high fracture risk (April 2019); the 12-dose, once-monthly, 210 mg treatment structure; the boxed warning and one-year post-MI/stroke contraindication; the general principle that stopping romosozumab without a follow-on antiresorptive leads to loss of bone density gains; the general structure of Medicare Part B buy-and-bill coverage for physician-administered biologics; the legal framework allowing 503A compounding of patient-specific prescriptions.

Plausible but requiring current verification for Washington specifically: exact WAC list price and full-course cost; Washington Apple Health's current prior-authorization clinical criteria and processing timelines; which named Washington commercial insurers cover romosozumab and on what tier; the current dollar terms of the Amgen/UCB savings card; the practical availability of compounded romosozumab from a Washington 503A pharmacy.

Not established from the source material used to build this page: specific fracture-risk-reduction percentages and cardiovascular event counts from the ARCH and FRAME trials (the trials exist and are real, but this draft could not confirm the exact figures against a verified, correctly linked primary source); a specific cost-per-QALY figure for romosozumab in the US; any direct quotation from a named physician, since the quotations in the source material could not be verified as accurate or correctly attributed.

Verification checklist: stable facts versus facts that expire

Use this before quoting a price or coverage rule from any Evenity cost page, including this one.

Stable facts (verify once against a primary source, unlikely to change month to month)

• FDA approval date and indication: confirm directly against the FDA's current drug approval database
• Dosing regimen and 12-dose treatment limit: confirm on the current FDA label
• Boxed warning and MI/stroke contraindication window: confirm on the current FDA label
• General guideline positioning (romosozumab as an option for very-high-fracture-risk patients): confirm against the current AACE/ACE guideline or a current Endocrine Society guideline, not a quoted excerpt
• Legal framework for 503A compounding: confirm against FDA guidance and Washington Department of Health pharmacy rules

Date-sensitive facts (re-verify before relying on them; state the check date when you cite them)

• Current WAC list price and course total: check a pharmacy benefit lookup tool or the manufacturer's pricing disclosure, dated
• Washington Apple Health's current prior-authorization criteria for romosozumab: check the Washington Health Care Authority's current preferred drug list or formulary, dated
• Which Washington commercial insurers cover romosozumab and their tier/cost-sharing: check the specific plan's current formulary, dated
• Amgen/UCB savings card eligibility, per-dose benefit, and annual cap: check Amgen's current program terms directly, dated
• Whether a specific plan uses a copay accumulator: check with the plan's benefits department, dated
• Real-world availability of compounded romosozumab from a licensed Washington 503A pharmacy: check directly with the pharmacy and its accreditation status, dated

If a fact in the second category appears in an article without a date attached, treat it as potentially outdated.

When to talk to a doctor or seek urgent care

Contact your prescriber promptly, rather than waiting for a routine follow-up, if you develop chest pain, sudden weakness or numbness, trouble speaking, or other possible signs of a heart attack or stroke while on Evenity, given the drug's cardiovascular boxed warning. Also contact your prescriber if you experience jaw pain, unusual thigh pain, or a new fracture during or after treatment. This article does not provide individualized dosing or eligibility decisions; those depend on your bone density results, fracture history, and cardiovascular risk profile as assessed by your own clinician.