@bswpb We are not all at the mercy of the insurance companies - some have opted for self-pay. Another poster's inspiring story likened her self-pay for an anabolic bone building drug to be like the choice to remodel a kitchen. Costs around the same, but she would rather have the best chance for remodeling her bones. With generic teriparatide (brand Forteo) now available self-pay for anabolic drugs is now an option for more of us.

It is worth it to try hard to get the insurance to pay for the better bone drug sequences. Some doctors offices have staff dedicated to insurance approvals/appeals. But I think about it for me as "these are not my practice bones" and plan to self-pay for teriparatide if insurance will only pay for bisphosphonates first to when I go on meds.

For example, you can now get a 28 day supply of teriparatide for under $1,000. Yes, a 2-year course will then cost nearly what a good 5 yo used Toyota costs and is not an option for everyone.
https://www.costplusdrugs.com/medications/teriparatide-560-mcg_2_24ml-solution-pen-injector-2_24/