Does Medicare part D cover Tymlos?

I started on Tymlos in March. My Part D prescription plan is Wellcare Value Script, and I use CVS Specialty pharmacy to have the pens delivered to my local CVS every month. For the first six months, I paid a grand total of $3321 for Tymlos. Beginning last month, it's been free.

I've been told by a little birdie that CVS will remain one of the preferred pharmacies for Wellcare, and Wellcare has already announced that the premium in my state will go from zero to $2.30/month next year.

Thank you

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.

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.

Checking Tymlos coverage:

Today I got a link from Medicare for the web page where you can compare plans, including Part D RX plans.
If you sign in to your Medicare account from there it will populate the drugs and pharmacies listed in your account. Or you can just enter the info yourself. It determines plans available to you based on your zip code.
In my county there were 12 Pard D plans. I ran a search listing only Tymlos as my RX. Per the attached, there were 2 Cigna and 2 AARP/United Healthcare plans that covered Tymlos so that the cost of it (and the rest of your covered drugs) is capped at $2,000. Note that based on the samples I ran, the deductible is NOT included in out of pocket costs. The rest of the plans do not. As I expected, the Wellcare plan I current have dropped Tymlos.
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https://www.medicare.gov/plan-compare/?utm_campaign=20241001_oep_mpf_ira_gsm_bb&utm_content=english&utm_medium=email&utm_source=govdelivery#/?lang=en&year=2025

Oops. Forgot to attach Tymlos search. Here it is.

There are two Wellcare plans on my list for Tymlos, but it's tricky because they display the plan in the list even if the drug is not covered. You'll see a crazy cost like $33K. I see I will have to select a new plan for 2025 for Tymlos.

As per a recent post, it looks like Wellcare won't be covering Tymlos in 2025. I see a Blue Cross plan that should work for me, though.

Correct. They used to have an option to select only plans that cover the selected drugs, but I couldn't find that filter here.

So it displays all plans available to you, and then when you look at the details it will say how many of your selected drugs are covered, and the details for a drug show that it is not covered and includes a street price for that drug That is why I did a search on Rymlos alone (since my prior searches included another drug that was also not covered, which also contributed to a very high price).

I used to get one of the 2 Cigna plans. Their formulary had most of the expensive ulcerative colitis drugs I took over the years and they were great on prior authorizations (unlike Wellcare). However Cigna dropped Safeway as network pharmacy from their plans so I wouldn't have been able to use the Safeway that is less than 2 miles down the road.

Of course, restructuring is exactly what will happen. I just reviewed my Notice of Annual Change in Benefits for my AARP/United Medicare Advantage Plan.

The drug plan deductible has increased from $295 to $420. I did not see yet whether that deductible is applied to the $2000 cap on prescription drug coverage but likely not, as deductibles have generally not been applied to meeting the out of pocket expenses under most medical insurance plans.

I also have not yet had a chance to check out what drugs may have been dropped by the new formulary 2025 but it appears that there may be a lot of shuffling about what meds may be in what Tier.

No one should be surprised by all these changes resulting from the new $2000 Part D cap. Someone has to pay and it will not be the insurers, the providers, or the pharmaceuticals.

With Medicare going broke (meaning not being able to pay under the present benefit structure) now expected by 2036, there will likely be huge changes on the horizon.

For those of us who are not dual eligible, (Medicare and Medicaid), nor eligible for a retirement related medical plan, we can probably guess who will be paying.