Has anyone had an increase in the cost of Tymlos in 2026?

Posted by zygote @zygote, Jan 25 2:37pm

My Endo is scaling back and now I am seeing a PA in his office. She renewed my Tymlos and the cost now (2026) is $225 a month which is a 225% increase for me. Wondering if this increase is mandated from the government, from Aetna, or ?

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My husband has been on Tymlos for about a year. We have commercial insurance and his copay was $150.00/month. Last month he received a notice that his copay would increase to $350.00/month. He called our insurance, customer service confirmed the increase. He asked about the Tymlos assistance program and was transferred immediately to another rep who signed him up in about a minute. His new copay: $0. What surprised me about that (I went through a similar issue with Evenity) was how our insurance was willing and able to sign him up and how easily they did it. There were no barriers or questions about eligibility, no income question, only the fact that it's commercial insurance.

As to who is responsible for this pretty outrageous increase? I can't find the current wholesale cost of Tymlos. In 2017 when it was approved, it was $19,500 annually, or $1,625 a month, wholesale. GoodRx discounted insurance costs start at $2,577 and upwards per month. I suspect this increase is entirely due to the insurance companies who are exploiting efforts to lower costs for Medicare by increasing them for everyone else. The manufacturing company was bought in 2022 so the new owners may also have increased the wholesale cost.

Anyway, I hope this helps. The Tymlos site says it's available for Medicare Part D patients and 90% of commercial insurance patients.

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Profile picture for gowalking @gowalking

I think, and I could certainly be wrong, if you have Medicare, you cannot use the discount coupons.
Usually Medicare pays first, whatever their portion is. Then your supplemental coverage picks up whatever their portion is. Then you pay the rest until you have met your deductible.
These posts mention Blue Shield and Aetna so they may pick up the entire cost minus your co-pay to start?? Then when you go on Medicare, Medicare will pay their portion first then your supplemental coverage will pay their portion, then you pay your deductible. No matter which route you go...coupons, insurance coverage, out of pocket or Medicare, I don't think you would have to pay the full amount......Lets hope.
I don't think this is one of the Medicare drugs that is being cost negotiated. Most of those are more common and taken by large groups of patients. TYMLOS is not a well-known, highly prescribed medication yet.
During a hospital stay and two different doctors visits, I was asked for a list of my medications. All three asked "what is TYMLOS" Now I save the information that comes every month with my Pen so that all my doctors have it in my records.

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@gowalking, medicare patients are no longer precluded from participating in the discount program as we formerly were by law.
Roisin11's post encourages us to look for the best pricing.

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Zygote, the US government doesn't mandate pharmaceutical prices, unlike most other countries.

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Profile picture for roisin11 @roisin11

My husband has been on Tymlos for about a year. We have commercial insurance and his copay was $150.00/month. Last month he received a notice that his copay would increase to $350.00/month. He called our insurance, customer service confirmed the increase. He asked about the Tymlos assistance program and was transferred immediately to another rep who signed him up in about a minute. His new copay: $0. What surprised me about that (I went through a similar issue with Evenity) was how our insurance was willing and able to sign him up and how easily they did it. There were no barriers or questions about eligibility, no income question, only the fact that it's commercial insurance.

As to who is responsible for this pretty outrageous increase? I can't find the current wholesale cost of Tymlos. In 2017 when it was approved, it was $19,500 annually, or $1,625 a month, wholesale. GoodRx discounted insurance costs start at $2,577 and upwards per month. I suspect this increase is entirely due to the insurance companies who are exploiting efforts to lower costs for Medicare by increasing them for everyone else. The manufacturing company was bought in 2022 so the new owners may also have increased the wholesale cost.

Anyway, I hope this helps. The Tymlos site says it's available for Medicare Part D patients and 90% of commercial insurance patients.

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@roisin11

The cost (retail) on my statement for TYMLOS says $2,883.00 per pen.
Medicare pays a portion and our insurance picks up the remainder.

As to who is responsible for these increases.....I think you are right and pharmaceutical companies make a fortune. However, it also costs for research and development for new medications....but when they are cost prohibitive to the average income, many of us have to decide to go broke or buy meds. Sad, for one of the wealthiest nations in the world.

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