Tymlos - how does ANYONE on Medicare pay for this drug?

Posted by jclang @jclang, Sep 14, 2022

I have been 'beating the bushes' to find help. I make just over the financial cut-off line for Forteo and Tymlos is worse. Their financial 'cutoff' is 13,000 and change (you can't make more than that per year!!!)

I am disgusted. I have reached out to every possible financial support organization and nothing works. I am not rich but if I pay what they want me to pay I will lose my condo!

I've tried the PAN foundation and all others like it. Social Security's rule is that you not make more than 20k a year to get help.

I have severe osteoporosis. I can't take bisphosenates. I am really angry at these greedy drug companies.

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

@rajmayo22

I have been using Tymlos since 9/2022. I did not have any co-pay. Radius Labs paid my copay. I was told that that monthly copay was #350.00 However, 1/2024, my meds were subjected to Medicare Part D and I have a monthly copay of $150.00. I was able to switch back to my old insurance for meds and keeping my fingers crossed where Radius Lab would cover my copay next month and beyond.

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What is Radius and how do you get them to help? Qualifications to receive help?

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Radius Labs manufactures Tymlos. It pays for a copay about #350.00/mo for those who are not insured under medicare. If you are insured under medicare part B your out-of-pocket co-pay cost is $150.00/mo.

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@fili123

I’m also ineligible for Tymolos assistance. I changed Part D insurers and am awaiting approval and cost for this drug.
It is so unfair that both Tymolos and Forteo offer discount cards to those with commercial insurance but not to those with govt insurance. We also pay for our insurance even though it’s thru the govt.

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I believe that restriction actually comes from Medicare. They're the ones prohibiting any savings card/partnerships with pharma companies. I believe there's been some talk in the legislature about changing that, but nothing yet.

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I found financial help with “radius assist”. Their cut off is max 45000 income per year. I definitely qualified and receive 12 months of tymlos absolutely free

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I have Medicare with part B/ Blue Shield. I have AARP (united healthcare) prescription ins. Once I pay out the required amt. for prescription drugs (last year it was $8,000) and this year it is $2,000, my prescription ins/AARP/united healthcare pays the remainder for the year. I think you need to do a consult regarding ins. and change it. Pay the additional premiums. It is worth it.

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Many insurers won’t pay for TYMLOS unless you do step therapy. Which means did you try this, and it didn’t work, and then you tried the next drug , and it didn’t work so then your last drug option (TYMLOS) (because you tried step 1 and 2) and a bone building drug such as TYMLOS is deemed medically necessary by your doctor. And then it has to be on the DRUG Formulary. I ran into this problem. I was prescribed TYMLOS and then got a letter of denial because I didn’t try and fail teriparatide (the generic form of Forteo).

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@strongerbones

Many insurers won’t pay for TYMLOS unless you do step therapy. Which means did you try this, and it didn’t work, and then you tried the next drug , and it didn’t work so then your last drug option (TYMLOS) (because you tried step 1 and 2) and a bone building drug such as TYMLOS is deemed medically necessary by your doctor. And then it has to be on the DRUG Formulary. I ran into this problem. I was prescribed TYMLOS and then got a letter of denial because I didn’t try and fail teriparatide (the generic form of Forteo).

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Yes. Also, the insurers are dealing with the new $2000 cap by being a lot more strict about stuff like this (assuming they didn't drop support for Tymlos completely, as my old insurer did.)

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I have original Medicare . I waited a year for 2025 to start Tymlos in order to get the $2000 cap. Otherwise my out of pocket cap would have been over $13,000 per year. I switched to a differed part D plan that included the 3 drugs I might have needed to take: Tymlos, Forteo, Raloxifene. I pay extra premium for the new plan. Fortunately I was approved for the Tymlos Grateful for the $2000 cap. fortunately, so far I am tolerating the Telos. But if I need to switch to Forteo, at least it is a covered drug.

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I am on medicare part D Cigna and waited until this year to start Tymlos because of the $2,000 cap. Last year I did get approved but was on UHC advantage and didn't want to spend so much. I switched to original medicare this year. We will start the approval process in a few weeks and hope for the best. Cigna says they cover Tymlos, Forteo and Prolia.

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Talk to your endocrinologist about getting it at little or no cost through the pharmaceutical company. I am low enough income that I qualify for Forteo directly from Eli Lilly ---- Lillycares.
It is easy to apply and the doctor helped me.

P.S. No one should select UHC - Medicare Advantage. Terrible insurance. Sick people cannot navigate the loops and hurdles you must go through.

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