1. < Osteoporosis & Bone Health

Tymlos cost

Posted by yogagirl57 @yogagirl57, Oct 26 8:37am

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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yogagirl57 | @yogagirl57 | Nov 12 1:20pm
In reply to @jamiebones "Hi, What I am thinking is fix the tooth with a temporary fix, wait at least..." + (show)
@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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yogagirl57 | @yogagirl57 | Nov 12 1:22pm

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

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1 reply
idlehands | @idlehands | Nov 12 1:48pm
In reply to @yogagirl57 "@idlehands OK, I'm afraid to ask. How much?" + (show)
@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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ecu123 | @ecu123 | Nov 20 11:38am

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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1 reply
kh58 | @kh58 | Nov 20 5:08pm
In reply to @njx58 "Yes. I used Wellcare Value Script this year, but they've dropped Tymlos for 2025, so I..." + (show)
@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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2 replies
njx58 | @njx58 | Nov 20 6:19pm
In reply to @kh58 "Hello, just saw this and new to this site. I have the same issue. I have..." + (show)
@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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idlehands | @idlehands | Nov 20 6:27pm
In reply to @kh58 "Hello, just saw this and new to this site. I have the same issue. I have..." + (show)
@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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kh58 | @kh58 | 6 days ago
In reply to @ecu123 "I am new to this site and Tymlos. Wellcare just approved my Tymlos (10/2024 - 11/2026)...." + (show)
@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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