I have traditional Medicare with Part D coverage.
- In 2023 I had a Cigna Part D plan. As others have noted, you have to get a plan that includes Tymlos in its formulary - which the Cigna plan did.
- Cigna gave me a 2 yr prior approval when I started in 2022. In 2023 I paid $405 for a 90 day supply (actually 3 pens x 28 days).
- I had 3 pens left in the "2 yr" (24 pen) RX when I changed to a Wellcare plan in 2024.
- Although Tymlos was in the Wellcare formulary, they wouldn't approve the last 3 pens, with a gobbledygook response that I had already gotten enough.

The Part D rules have been changing. In 2024 you no longer paid anything once you reached what used to be the catastrophic tier. And as I understand it, in 2025 there will generally be a cap of $2,000 on what you pay. I'm afraid the net effect will be that insurance companies start dropping more expensive drugs like Tymlos from their formulates, but maybe not.

Personally I no longer have that issue since I followed Tymlos with a Reclast infusion, which is fully covered under Part B (+ my Physicians Mutual supplement). All I can say is hopefully you can still find reasonable Tymlos coverage, but be sure to ask lots of questions about how things will play out in the future (v just past experience). Good luck .