Just getting started…

Posted by marianq @marianq, Sep 27, 2021

Good morning. I was just diagnosed with osteoporosis so I’m a bit overwhelmed. My endocrinologist suggested a few medication treatments for me based on my overall medical situation.
One medication that was covered by my Medicare Part D prescription insurer is Tymlos - tier 5 in my plan (never heard of tier 5!). I got a script for this and cost is $584 a month - which I really cannot afford. Manuf drug coupon says doesn’t cover Medicare due to gov’t regulations. Anyone else dealing with this? Any suggestions?
The other possible medications doctor suggested were Evenity or Forteo. Neither are covered currently in my plan however doctor could request a prior authorization to be added to my formulary list. But even if she got one approved, don’t you think these will be even more expensive?? Should I try getting a script for one of these - assuming I could get PA approved?

I don’t want to get on a soapbox here but why are seniors on Medicare penalized by drug companies or why do govt regulations not allow Medicare use these coupons. I probably won’t qualify for “help” but doesn’t mean I can afford. Thanks so much listening. Just looking for any advice.

Interested in more discussions like this? Go to the Bones, Joints & Muscles Support Group.

@marianq

KLH, thank you so much for your reply. I will definitely explore all the options available here. I’ve never heard of Radius Assist Program but I’ll absolutely give them a call.

Thank you again. I’ll definitely keep you updated. I am worried about the side effects as well. I’m already disabled with terrible arthritis in many places but I’m going to keep a positive attitude throughout this process.

Have a wonderful day, KLH.

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Hi, thanks for the reply. I hope I helped a little. Let me know how you come out. I will keep you in my thoughts. KLH

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@kilh

Good morning, I have Radius Assist approval but when I stopped I thought it was for good. Never thought the docs would let me start again. I have been approved for 18 months for free to be started in Oct. or Nov. We have not made the final decision as to when it will start since I have two months in the refrigerator. Hope you are well and safe. How are you and Tymos getting along. I am back on 2 clicks for another week then 3 clicks. All seems to be going well.

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The ASSIST program is still there for you. No need for docs to get involved other than to make sure Rx is still current. Call Tymlos support and the pharmacy you dealt with. I stopped and started and my ASSIST was still available without me doing anything other than calling the pharmacy.

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@marianq

Thanks Windyshores. Appreciate your input as well. You given me hope that maybe I can get assistance from Radius with income level.

Have a wonderful day. 😁

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Good luck!

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@windyshores

The ASSIST program is still there for you. No need for docs to get involved other than to make sure Rx is still current. Call Tymlos support and the pharmacy you dealt with. I stopped and started and my ASSIST was still available without me doing anything other than calling the pharmacy.

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That being said you still have to reapply for 2022. They told me usually in November they make their decision. I know have three months this year but have to send in new paperwork with my tax form from 2020. Do you not have to reapply also? My docs wanted 24 months on Tymlos but Radius only gives you 18 months free. That is why I have already bought six months of Tmylos so I should not have any more to pay for. How does it work for you?
Hope your cold is better and you are well. Take care KLH

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@kilh

That being said you still have to reapply for 2022. They told me usually in November they make their decision. I know have three months this year but have to send in new paperwork with my tax form from 2020. Do you not have to reapply also? My docs wanted 24 months on Tymlos but Radius only gives you 18 months free. That is why I have already bought six months of Tmylos so I should not have any more to pay for. How does it work for you?
Hope your cold is better and you are well. Take care KLH

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Yes I have to reapply. Everyone does.

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@windyshores

Yes I have to reapply. Everyone does.

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When do you usually reapply? And does the doc have to fill out paperwork again or just sent in your tax form since I was told I was approved for 18 eighteens just needed to check income for 2020? And since I have not used any months yet hopefully I can get three months in this year. I know our income will be lower than 2019 because we cut back to only renting 1 farm instead of two beside the home place and in May the whole flock of sheep went to market so no feed, labor, and vet bills. We had had the sheep since 1979. No chores for me which help the stress on my bones. Now the cows are only on two places so cut down on the number of mother cows and one bull sold. This makes it easier on two old folks. Hope you are fine and thanks for the info. Stay tunesKLH

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@marianq

Thank you so much, Chris. If I could work something like that, I could afford it with all my other medications. May I ask a few clarifying questions?
- RX Folks: Is that your insurance folks thru AARP?
- “I was able to manage the cost with the gaps and the end runs”. Not sure I understand this? Could you clarify?

Do you recommend I call the manuf and ask what assistance that might be able to give me?

The other thing I was thinking of during Medicare Open Enrollment (starting Oct 15th through Dec 7th), I would see what insurance plan might help and look to switch to this insurer for 2022.

Thanks again, Chris.
If anyone has additional suggestions, please respond. I’m open to anything. Have a wonderful day.

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Good afternoon.......let's see if I can explain what I meant. Sometimes I forget the techie names. So...here goes,
Yes. OptumRX is the AARP pharmacy.

The gaps and end runs are the Medigap phases where you pay more or less for a time based on how much you have paid overall. Then....at the end of the year, if you have paid a lot, you kind of get a free ride. So...here goes. In the beginning of the year.....it was $1500 which included the original deductible. Then it evened to about $500 and at the end of the year, each Packett was $99 which I named the end run.

I found that both Optum and Amgen were helpful every time something changed and I needed clarification. The medical professional at Amgen would consult with the research staff and get back to me. They treated me well. The manufacturer has a patient assistance program that helps with outside funding. Optum can save you some $$$$ by sharing information you might not have.

Regarding Enrollment........I meet with an insurance advisor every year. We go over the prior year and try to anticipate the next year. That is very helpful. She also sets up everything with the insurance entities for me like automatic payment.

Hope this is helpful..........sorry for me substitute names. What is your priority right now?

May you be mentally and physically well.
May you have comfort and ease.
Chris

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Amgen told me they do not have an assistance program. They have a connection to a foundation that may or may not have funds at the time. Curious why you heard Amgen does have assistance.

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Just had my first injection of Evenity
I just started Evenity a week ago. I did struggle with making the decision of which medication to take as I was worried about the side effects but my endocrinologist said the heart/stroke side effects are rare. She did say she sees more leg pain and headaches - unfortunately I already have chronic leg pain (with a loose hip replacement and an ankle that needs to replaced soon enough). My question is anyone on Evenity experienced the leg pain and if so, what’s it like? How soon after getting your 1st injection, did this happen? I have so much pain in my legs now - I can’t tell if I’m truly having side effects from Evenity or not.
Anything else should I be aware of?

I hate to be so fearful but just knowing what others have experienced is helpful to me. Thank you in advance for your help/support.

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I called "Forteo Connect" and was given the following to be considered for financial assistance. I would guess they consider other medications besides Forteo.

HealthWell Foundation
This nonprofit organization helps needy patients pay their insurance premiums, as well as prescription drug and other out-of-pocket costs. You can apply online (your doctor needs to fill out a form too) for up to a year’s assistance. After that, you’ll need to reapply. ‭(800) 675-8416‬

Patient Access Network Foundation
For U.S. residents who are being treated for one of 21 diseases on this organization’s list—which includes breast cancer, cystic fibrosis, and multiple sclerosis—Patient Access offers $1,500 to $8,500 of assistance toward medication costs for one year. You’ll hear back on your online application within 48 business hours. 866-316-7263

Patient Advocate Foundation
If you’re insured, Patient Advocate can help with your pharmaceutical co-payments. The foundation offers assistance to those with diseases such as diabetes, osteoporosis, rheumatoid arthritis, and various cancers. 866-512-3861

Lilly Cares Foundation, Inc. is a nonprofit charitable organization that provides prescribed Lilly medications for free for up to 12 months to qualifying U.S. patients. Over the past 20 years, Lilly Cares has helped more than one million patients with financial need receive medicines donated by Lilly. 800-545-6962

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