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Does Medicare part D cover Tymlos?
Osteoporosis & Bone Health | Last Active: Nov 11 10:38am | Replies (26)Comment receiving replies
My Medicare part D plan is ASRP/United Healthcare which has Walgreens as the preferred provider. However, when I initially started on Tymlos in June of 2023 my doctor only worked with CVS specialty pharmacy. In January of 2024 I believe that I paid around $1,000/mo for the Tymlos. Since meeting my catastrophic amount in March it has been free of charge (I am taking some expensive meds). In 2025 with the change for max OOP decreasing to $2,000 it should be more affordable for everyone.
Replies to "My Medicare part D plan is ASRP/United Healthcare which has Walgreens as the preferred provider. However,..."
Note that a drug must be listed on your Plan D plan's formulary for the 2000$ cap to kick in. So far I have found 4 plans in my state (Utah) where it is listed, but on the Medicare site it doesn't show the $2000 limit applying so they are listing the cost to tymlos for 12 months to be 38,000$. I'm now trying to call each of the plans to see why tymlos is listed on their formulary but it doesn't seem to trigger to $2000 cap. Worried!
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What some people don't realize when they are signing up for Tymlos is that you can't just get it at any pharmacy. The Tymlos manufacturer Web site clearly says that Tymlos is *only* available via specialty pharmacies. Forget about bringing your prescription to the local CVS or Costco or Walgreens. There's a special prescription form on the Web site; I gave it to my doctor along with the contact information for CVS Specialty pharmacy.
For anyone using Wellcare who is getting ready for this: never,ever, ever pick Acaria Health as the pharmacy. Pick CVS. Trust me.