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Tymlos - how does ANYONE on Medicare pay for this drug?
I have been 'beating the bushes' to find help. I make just over the financial cut-off line for Forteo and Tymlos is worse. Their financial 'cutoff' is 13,000 and change (you can't make more than that per year!!!)
I am disgusted. I have reached out to every possible financial support organization and nothing works. I am not rich but if I pay what they want me to pay I will lose my condo!
I've tried the PAN foundation and all others like it. Social Security's rule is that you not make more than 20k a year to get help.
I have severe osteoporosis. I can't take bisphosenates. I am really angry at these greedy drug companies.
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@diane2154 Yes. Tymlos was originally denied by my Medicare Part D insurance company. My provider had to appeal, and ithe appeal was approved.
@diane2154 Yes. Tymlos was originally denied by my Medicare Part D insurance company. My provider had to appeal, and ithe appeal was approved.
Tymlos was not on my formulary list. So the appeal had it added as an exception.
@cathyf31
I just found out the appeal was denied. I am disgusted. I am doing well on Tymlos and now cannot continue. I am sure one month of medication did nothing but delete my wallet of $1089. Waiting to hear what my doctor has to say.
@diane2154 So sorry. My P1NP climbed from 52 to 93 in 23 days. So you likely also had gains. I wonder if your doc can appeal the denial???
@cathyf31
I am hoping she can. Those numbers are impressive. I will keep you posted.
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1 Reaction@diane2154 Please do.
@barb3
Hi. Thank you for your message.
For some reason I think I have taken it along with Boniva and other stuff. Quite a few years ago they said that I had exceeded my lifetime dose. Nice. At lease 10-15 years later. It’s so bad. I live on Prednisone for Adrenal insufficiency.
I had another one that you went to the hospital for infusion. That’s how long ago it was
Another fear. lol. Osteosarcoma
Before they were leery with Prolia I think it was.
I was dx with Retroperitoneal Liposarcoma 2006. I had large tumor and my right kidney removed. But I have been so fortunate. I am still here. Just lots of side effects. I still feel blessed.
But that warning scares me? Comments
@barb3 , I just checked my insurance and teriparatide is still a tier 5 with a prior authorization needed. It has the same criteria for approval as Tymlos. I may just have to take my chances with diet and strength training till I am able to switch insurance. Still waiting to hear from my doctor. Thank you for the advice.
@diane2154, I have wondered whether Tymlos is expensive for the companies and that's why they don't tend to cover it (at least here is PA). I remember I checked my drug formulary for the criteria they use for Prior Approval and sent it to my doctor. Not sure whether she used that or not. But I had tried and failed with lots of bisphosphonates and Reclast too, and my DEXA numbers showed severe osteoporosis and those things factor in as well. Wishing you better luck going forward.
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1 Reaction@juliasbeach
Last Dec I found only 1 medicare D in my zip code (Los Angeles) that supplied Tymlos in its formulary. my 2024 plan eliminated it for 2025 in its formulary. I'm now on AARP UHC. However the premium is high at $160/month. As others noted, you need to get an authorization from your MD as well. I will be going off tymlos at the end of the year and will switch D plans based on which ever medication I will be going on to follow tymlos. I meet with my endocrinologist in November to have that discussion.