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@windyshores , @gently @mayblin i wasn’t sure where to post this. I just received a denial for prior authorization for Tymlos saying the medicine can only be approved if the patient has a diagnosis of postmenopausal women with osteoporosis (my hip is -3.8) at high risk of fracture. I fractured my hip and wrist 5 months ago.
Dexa says 10 year fracture risk not reported because some t-score for spine total or hip total or femoral neck at or below -2.5. My spine is -3.1 and my femoral neck is -2.4.
Should I first talk to my doctor on how to appeal this? Any advice would be appreciated from anyone who has gone through this. Thanks so much.
Replies to "@windyshores , @gently @mayblin i wasn’t sure where to post this. I just received a denial..."
Yes. Make it known to your doc and see if he is able to intervene in some fashion
@bluebonnet242 Your prior hip fracture and your t-scores are all totally in support of high risk of fracture. A prior lumbar or hip fracture is about is complete evidence of high risk. Nothing else should be needed. If it was a -3.8 for total hip is definitely high risk. Definitely appeal. Is this an insurance company or Medicare? Persist and you should get this reversed. Good luck.
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You could start a new discussion so more ppl can see your message and chime in. You need an endo to appeal and appeal again
There are frax calculators online, different versions, that you can use to calculate your frax risk. But your recent fractures could easily put you in osteoporosis category even you have t scores in osteopenia range. Some endos diagnose op that way. Of course, the circumstance under which you broke your bones counts.