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My mother is on prolia and has not had any injection issues or reactions. The shot needs to be done every 6 months. In order to be covered by Medicare, the shot has to be done in the doctor's office. Mom's AL doesn't want her to leave, as this would endanger her caretakers and other residents. If the injection is transferred to the AL pharmacy, we would bear the $1200 cost out of pocket. Why is Medicare making us choose between a substantial cost and our health? Her backup insurer is Tricare.

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I would call your insurer, explain the circumstances - who will actually be giving the shot, by the way? - and ask for the stipulation about the doctor's office to be suspended. I'd bet you won't be the first to ask.
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imadaughter17 May 2020
The insurer is medicare.
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It's not her insurance but the AL doing this.

I would implement all the precautions and take her to the doctor.

Unless the caregivers are staying on site they are being put at risk every time they go in public and they are putting the residents at risk.

I would dress her and then put a house dress over her clothes, put a mask on, gloves and cover her hair. When you leave the doctors office remove everything and have her wash her hands or use sanitizer until she gets home, then she can shower and put all of her clothes and shoes in the wash. This is the best protection I've seen.

It takes effort to be protected from potential contamination and it is well worth it if you are fearful of infection.
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imadaughter17 May 2020
It's actually medicare's rules that are driving this. She has to be assisted in the shower - it's a scheduled thing. There are a few cases already at the complex so they are trying to reduce chances for infection.
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Does the injection have to be done every six months. I have read where after a point, these injections don't really help anymore. I don't see where waiting a while longer will make that much difference.
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imadaughter17 May 2020
Yes. Supposedly it has to be that schedule to insure it stays effective. Plus trying to push the boundaries means the next shot will be in December or January and we live in Wisconsin.
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Medicare in itself does not handle prescriptions. I just looked it up, and Medicare Part D is what covers Prolia. So Mom should have a separate insurance that covers Part D. It could be part of her supplimental. With me BC/BS is my supplimental and Express Scripts is my prescripton plan.

Once you have found what plan handles her prescriptons you can call them and ask if because of the virus can they allow Mom to get the injection at her facility.

I just read up on this drug and it says its used only when other options have been tried.

"Long-term use of bisphosphonates increases the risk of fractures so they should not be used beyond 3-5 years. Prolia, with the generic name Denosumab, is a type of monoclonal antibody, which stops the natural breakdown of bones. Prolia is injected two times per year."

Read up on this drug. Not sure at 91 if its really going to help anyway.
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