Evista (Raloxifene) Medicare Coverage

Evista is a medication that contains the active ingredient Raloxifene. It is commonly used to treat or prevent osteoporosis in postmenopausal women. It is also used to reduce the risk for invasive breast cancer in women who are considered at high risk.

Evista increases estrogen in the bones to prevent bone loss and blocks estrogen in the breast and uterine tissue to reduce the risk of cancer. It is usually taken once daily.

Side effects of Evista include hot flashes, leg cramps, flu-like symptoms, sweating, headache, upset stomach, diarrhea, muscle or joint pain, insomnia, stomach pain and signs of a common cold.

Does Medicare cover Evista or Raloxifene?

While some Medicare plans may not cover Evista, some Medicare Advantage plans and Medicare Part D plans may cover Raloxifene.

• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.¹
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Raloxifene.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Average costs for Raloxifene with Medicare drug coverage

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in and the Medicare drug plan you have.

Additional information

Evista does not eliminate the risk of breast cancer. You should continue to have regular breast exams and mammograms while taking this medication. Continue self-exams at home and let your doctor know if you experience a lump in the breast, breast pain, soreness or discharge.

If you use Evista for breast cancer risk reduction, it is usually taken for 5 years. It may be used for longer than 5 years in women who have osteoporosis.

Evista can raise your chances of having a blood clot. Do not use Evista if you have had a blood clot in the past. Signs of a blood clot can include chest pain, shortness of breath, swelling, warmth, change in color or trouble speaking or swallowing.

Evista can also increase your risk of having a stroke. Signs of a stroke include weakness on 1 side of the body, trouble speaking or thinking, change in balance or drooping on one side of the face.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.