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

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

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.

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.

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

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.

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).

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.)

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.

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.

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.