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mblatcher avatar

Anabolic Osteoporosis Drugs

Osteoporosis & Bone Health | Last Active: 2 hours ago | Replies (30)

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Profile picture for Justin McClanahan, Moderator @JustinMcClanahan

Hello @mblatcher,

Impending insurance uncertainty must be a complicated thing to deal with on top of your osteoporosis diagnosis and weighing which treatments might be best for you. If your rheumatologist thinks Evenity would be best for you due to your age, have you asked them to help you file an appeal with your insurance company on your behalf?

Mayo Clinic Connect is a space where members can share their experiences and to help members gather information to discuss with their providers. Through shared experiences we can help make more informed decisions with our provider's but decisions with powerful medications like osteoporosis meds should always be done in lockstep with your provider. You mentioned should you wait to see what your new insurance plan covers, have you discussed the risks with waiting a few months with your rheumatologist? Are there worries that you may start Tymlos but if your insurance changes you won't be able to finish the full thing if it too is not covered come January 2026?

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Replies to "Hello @mblatcher, Impending insurance uncertainty must be a complicated thing to deal with on top of..."

@JustinMcClanahan
I have worked with my rheumatologist to file a total of 4 appeals with Aetna. Each time, the answer was the same- “Evenity cannot be approved because you have not trialed and failed to respond to Prolia”. Very disappointing to say the least. I got my diagnosis on Dec 30 2024. Here I am in October without having made any progress. My rheumatologist was trained by one of the top Osteoporosis docs in the country and I place a lot of trust in her. Unfortunately, she has now left the practice. I will meet her replacement once I start the Tymlos. But who knows who will be in-network come January when my new insurance will kick in. So I might be back to the drawing board. The good news is that whatever insurance I can afford (I’m self insured) should cover Tymlos if I have already begun taking it. I just need to do the training for self-injection, so I should begin pretty soon. The last 10 months have been a roller coaster to say the least!