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.

How much does Raloxifene cost with Medicare?

Raloxifene coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Raloxifene?

According to GoodRx, 100% of Medicare Advantage plans and Medicare Part D plans covered Raloxifene, the generic form of  Evista, in 2023.¹

• Medicare Advantage plans or Part D plans that cover Raloxifene include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.²
  
  
• 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. We represent carriers such as Humana, Aetna, UHC, Anthem BCBS, Wellcare, Cigna Healthcare, and Kaiser Permanente.

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.

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.