Tymlos cost

Posted by yogagirl57 @yogagirl57, Oct 26, 2024

Hello! I just was recommended Tymlos from my Endo. Can anyone tell me how much or if it is covered by insurance? I have Blue Cross Blue Shield Federal. TIA.

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@jamiebones

Hi, What I am thinking is fix the tooth with a temporary fix, wait at least 3 months to do the oral surgery. Fix any other teeth which may have old fillings and might do the same thing. Then start on a med for osteoporosis. Actually my doctor wants to start Tymlos, which is an injection every day, OMG!! I'm still searching for answers, keep in touch.
Jamiebones

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@jamiebones This is funny because I am going through a dental nightmare right now where I think I need 2 root canals. There is no way I start any Tymlos until this situation is over. I also have a Uveitis flare (inflammation of the retina) so I'm dealing with that too! After I get all this fixed up I will probably start Tymlos. I have too many other things going on right now.....

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@idlehands OK, I'm afraid to ask. How much?

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@yogagirl57

@idlehands OK, I'm afraid to ask. How much?

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@yogagirl157, Humana's retail cost is $2667 a month. For me, my copay is $707.

But Jan 1st the Medicare coverage gap ends and covered meds will have a $2000 out of pocket maximum for the year.

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I am new to this site and Tymlos. Wellcare just approved my Tymlos (10/2024 - 11/2026). Does that mean they will cover Tymlos for me even it's not on their Formulary list. Thanks.

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@njx58

Yes. I used Wellcare Value Script this year, but they've dropped Tymlos for 2025, so I am switching to another plan.

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Hello, just saw this and new to this site. I have the same issue. I have Wellcare with approved exception for Tymlos that started August 2023 and expires August 2025. I was on the phone with them this week trying to determine if the exception on file will allow it to be covered until expiration. I was told, after being put on hold twice, that it was covered. However, I did not feel very confident with the customer service rep. I asked for something to confirm and they are sending a coverage determination via mail. I have my doubts and have selected another plan to enroll in that does cover Tymlos if the letter is not what I expect.

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@kh58

Hello, just saw this and new to this site. I have the same issue. I have Wellcare with approved exception for Tymlos that started August 2023 and expires August 2025. I was on the phone with them this week trying to determine if the exception on file will allow it to be covered until expiration. I was told, after being put on hold twice, that it was covered. However, I did not feel very confident with the customer service rep. I asked for something to confirm and they are sending a coverage determination via mail. I have my doubts and have selected another plan to enroll in that does cover Tymlos if the letter is not what I expect.

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I have Wellcare this year (Medicare Part D), and they dropped Tymlos from the formulary for 2025. I signed up for a new plan effective January.

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@kh58

Hello, just saw this and new to this site. I have the same issue. I have Wellcare with approved exception for Tymlos that started August 2023 and expires August 2025. I was on the phone with them this week trying to determine if the exception on file will allow it to be covered until expiration. I was told, after being put on hold twice, that it was covered. However, I did not feel very confident with the customer service rep. I asked for something to confirm and they are sending a coverage determination via mail. I have my doubts and have selected another plan to enroll in that does cover Tymlos if the letter is not what I expect.

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@kh58 and @ecu123 Wellcare - or any ins company - telling you they cover a medication means that they'll pay for some of it. But it's probably a Tier 4 or Tier 5 drug and what they cover may still leave you with a high copay. Their pharmacy, or whoever is actually supplying the drug to you, should be able to quote you the price.

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@ecu123

I am new to this site and Tymlos. Wellcare just approved my Tymlos (10/2024 - 11/2026). Does that mean they will cover Tymlos for me even it's not on their Formulary list. Thanks.

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I have the same question regarding WellCare moving Tymlos to Non-Formulary for 2025. My approval is 8/2023 - 8/2025.

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@oopsiedaisy

I experienced sharp intermittent twinges of pain in my extremities and joints (fingers, toes, calves, knees, and forearms). It was unpleasant but not constant. It happened mostly in bed at night or in the morning and not every day. I took my Tymlos dose at bed time.

I’ve been off Tymlos for a week now and they have completely disappeared. I am waiting for approval for my teriparatide prescription to be filled so I am off everything right now.

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@oopsiedaisy
Our insurance company changed in the new year and it looks like our new company is declining my prescription for Tymlos ( they say I don’t need it and should use fosomax….still think it’s crazy these companies can dictate over docs!). I’ve been on Tymlos for about five months, and recently started to experience the same pains you described (which I would enthusiastically ignore if I could continue with Tymlos). How are you doing on forteo? Since I might have to self pay I am looking at generic forteo with Goodrx…….just wondering what your experience has been switching….thx for any insights!

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@babbsjoy

@oopsiedaisy
Our insurance company changed in the new year and it looks like our new company is declining my prescription for Tymlos ( they say I don’t need it and should use fosomax….still think it’s crazy these companies can dictate over docs!). I’ve been on Tymlos for about five months, and recently started to experience the same pains you described (which I would enthusiastically ignore if I could continue with Tymlos). How are you doing on forteo? Since I might have to self pay I am looking at generic forteo with Goodrx…….just wondering what your experience has been switching….thx for any insights!

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I went through this when I had to switch plans. I got my doctor to send a letter of necessity to the insurance company. Since I was already on Tymlos, interrrupting the treatment was reason enough to appeal the decision not to cover it.

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