insurance stopped my medication

I am 75, not a candidate for hrt because of previous breast surgeries.

I am sorry to hear your dilemma. Forteo has generics now. Does your insurance cover any of the generic versions? They are a lot cheaper.

I wonder if your endo ever thinks Evista (raloxifene) is suitable for you. It's a mild antiresorptive and could hold your bone density somewhat stable while you wait for next step... Evista is often used in women who has high risk of breast cancer since it doesn't interact with estrogen receptors in breast (actually acts as an 'antagonist' at estrogen receptor which blocks estrogen's effect hence carries no breast cancer risk). It's slight clotting risk needs to be discussed with your physician.

Evista was tried for 2 years and bad results. Not an option. Insurance won't cover Forteo or generic or tymlos because I used up my allotted time on them and they don't care that it was needed for the necrosis as that is not what it is usually used for.

Who is your insurer?

In your situation, I would contact Medicare Rights Center and see whether: a) the insurer can deny treatment if it is medically necessary and b) whether the Center can provide some advocacy assistance.

@rjd- I agree, name the insurer and publish the reason for denials, is it medicare alone?
@magwil01 at over 70 years and with a history of health issues should not have to fight insurance denials - health care decisions should not be at the mercy of insurance companies -

Not medicare. Military prescription - Tricare. Reason: Forteo only allowed 24 months.
Doctor appealed on two counts 1) it has been approved for 48 months, Tricare has outdated info
2) this is the only medicine that is able to postpone necrosis caused by other medications. Appeal was denied just repeated the same reason (24 months allowed).

If you are 75 years old, are you not receiving Medicare with Tricare being secondary insurance plus providing medication coverage?

If I was you, I would still contact the Medicare Rights Center. They would likely understand what is going on, hopefully advise you, and if indeed Forteo is the only medical treatment for your situation, can possibly provide some advocacy assistance. Perhaps there is some sort of 'exception' procedure lurking about in the bowels of Tricare.

Tricare alone handles the forteo. I only have medicare AandB and no RX. My meds never go through Medicare. Tricare has turned down the appeal twice. They wouldn't even listen to the doctor.

You need to find help from some entity that understands the very complex system of providing health care to seniors to see whether you still have any options.

I have heard about 'exception' procedures for denials of medical treatment, including for prescription drugs. Contacting the Medicare Rights Center should be considered.

One advantage of injections like Prolia or Reclast is that it is done in the doctor's office and therefore gets submitted as a Part B claim, rather than as prescription coverage. The Medicare RX providers are getting very strict. They have to cover that $2000 cap somehow!