1. < Osteoporosis & Bone Health

Does Medicare part D cover Tymlos?

Posted by hopefulheart @hopefulheart, Sep 4 12:19pm

I will begin Medicare in February and wondering if Part D covers Tymlos

My current commercial insurance I would pay $2,600 a month for Tymlos
I can’t pay that

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betterbones | @betterbones | Oct 22 12:38am

My Well Care for 2025 lists Tymlos as Non formulary-- but gives it a number 25061-- with alternative meds as teriparatide and Prolia. Neither Reclast nor Zoledronic acid come up in the drug search

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2 replies
betterbones | @betterbones | Oct 22 12:58am
In reply to @betterbones "My Well Care for 2025 lists Tymlos as Non formulary-- but gives it a number 25061--..." + (show)
@betterbones

My Well Care for 2025 lists Tymlos as Non formulary-- but gives it a number 25061-- with alternative meds as teriparatide and Prolia. Neither Reclast nor Zoledronic acid come up in the drug search

Jump to this post

I liked Well Care and they approved my preauthorizations, but now will switch. Thanks for the tips on Cigna- Their Assurance RX plan says monthly costs will be $615 until deductible met; their next plan would be $763.06. Also, I now realize that Reclast is not listed because it is an infusion, covered by Part B if applicable. Tymlos worked well for me.

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njx58 | @njx58 | Oct 22 5:28am

Wellcare dropped coverage for Tymlos for 2025. I am switching to a Blue Cross plan.

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hardingv | @hardingv | Oct 22 11:36pm
In reply to @betterbones "My Well Care for 2025 lists Tymlos as Non formulary-- but gives it a number 25061--..." + (show)
@betterbones

My Well Care for 2025 lists Tymlos as Non formulary-- but gives it a number 25061-- with alternative meds as teriparatide and Prolia. Neither Reclast nor Zoledronic acid come up in the drug search

Jump to this post

A Reclast/zoledronic acid infusion won't show up on a Part D plan formulary because it is covered by Part B, not Part D

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tmmayo | @tmmayo | Nov 10 12:49am
In reply to @ymv "My Medicare part D plan is ASRP/United Healthcare which has Walgreens as the preferred provider. However,..." + (show)
@ymv

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.

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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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idlehands | @idlehands | Nov 11 10:38am

Humana Medicare Advantage covers it (in Ohio). In 2024 it's tier 5 and the cost is $2667/month, tho my copay is only $707. They can't quote a cost for after Jan 1, but it doesn't matter (to me) because it will be covered by my $2000 out-of-pocket maximum. If you find a plan that covers it, wait till January if you can.

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