Tymlos cost

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.

@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!

I was cut off Tymlos after four months. I am starting on generic Forteo (teriparatide) now which they will cover.

@oopsiedaisy

I am glad there is something in that class they will cover for you! Unless my doctor can successfully appeal, I will have to either self pay or go to a bisphosphonate (which Cigna is saying is appropriate for me). Since I already have acid reflux, and very much believe in my current treatment plan, I will try to do generic forteo if at all possible (still very expensive!). Please let us know about your generic forteo experience! (And was your doc worried at all about the gap between having to stop tymlos, and starting teriparatide? Or, was good to have a little gap between the two meds?). Thx for any info….

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.

@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!

I was on Fosamax for over five years. I fractured while on it, I believe partly due to Fosamax shutting down all bone remodeling resulting in older, dryer, and more brittle bones.

My rheumatologist was not concerned in the least about the gap, which was nearly three months. Nor was she concerned about the fact that bisphosphonates reduce the efficacy of anabolics like Tymlos and Forteo due to the release of the bisphosphonate when bone remodeling restarts. The bisphosphonate is reaborbed by the bone which then inhibits bone remodeling again.

I am switching doctors in the near future to an osteoporosis clinic as I’ve realized from reading the experiences here that I need a plan for the rest of my life that includes multiple components (medication, diet, exercise, supplements, etc) and my current doctor is uninterested in any of these.

My teriparatide is scheduled to arrive tomorrow. It will be interesting to see how it compares to Tymlos. I had few side effects from Tymlos but it did have one side effect I found difficult and that was extreme constipation despite my being on a very high fiber diet due to a family history of colon cancer and some precancerous polyps on recent colonoscopies.

I wouldn’t consider Fosamax a good starting option if your doctor thinks you need to build bone. Fosamax will not do that for you. You may see an increase in bone density because it shuts down bone resorption to start but that will eventually slow down or stop. I had a gain for two years but then it stopped.

If you have acid reflux then Fosamax would not be a good idea, in my opinion. I never had the side effect that others experience with acid reflux and Fosamax which appears to be awful.

Not to open a can of worms, babbsjoy, but you may be able to change plans again. If you have a Medicare Advantage plan you can switch plans from 1/1 to 3/31. If you have some other kind of plan there may be an 'escape clause' that allows you to drop your new plan for a new new plan, and what njx58 described about you already being on the Tymlos might qualify you to do so. A lot of hassle, yes, but there are a lot of plans out there and there's probably one to suit you better.

Wouldn't a very high fiber diet *cause* constipation?

@idlehands
Thank you! That is a great idea. Our insurance is still commercial, through employer. I am pricing what it would be for me to go back to the old plan the employer dropped for another provider. Right now, it looks like similar coverage would exceed the cost of generic Forteo, but be less than trying to pay for Tymlos on GoodRX. Good grief!