First Evenity Dose then Denial

Good evening @txsurfer, and welcome to Connect. I don't know if I understand everything in your post. What I do understand is the formulary issue. I had the same problem with a new medication for me that was not on the Medicare formulary. All I had to do was request an "exception" and it went through. My insurance consultant told me that it is like a circle......you just keep going around and around while trying to figure out what to do next. A lot of it has to do with pharmaceutical companies attempting to control who will get their products. Evidently, there are sometimes reasons for denying access to those on Medicare.

I am facing a renewal requirement at the end of the year. Just in case I am getting all of the paperwork ready as it sounds like starting all over again.

It may be worth the struggle to get on Evenity as it is the only osteoporosis medication that not only builds bone, it also protects it without having to take a reabsorption preventive.

However, Tymlos was my choice for the initial program. I completed two years on Tymlos without any side effects and with improved Dexa scan scores. Then you would have to choose a different medication to protect the bone that has been created.

If you need further assistance, let me know.

May you have contentment and ease.
Chris

Fyi Tymlos has a patient assistance program (Radius Assist).

I have been told that it is okay to take Evenity after Tymlos, but not the other way around. I would consider doing Tymlos and save Evenity for later, but that's me.

I doubt one dose already taken matters. But ask your doc or the pharmacist.

Thank you Chris. Appreciate your help on this matter. Nice to hear Tymlos worked well for you. Congrats. Good luck on the renewal. Our doctor won't submit the exception request because it would require stating other drugs on the formulary such as Tymlos and Forteo are not effective or cause adverse effects. We are now considering switching our Medicare Advantage insurance to one that has Evenity in its formulary. Exploring all options as we go round and round on our little circle.

Thank you windyshores. Will definitely check out Radius Assist. I've also read Evenity can follow Tymlos but not the reverse which makes sense to me but I've not seen a study on this matter. My wife really likes your strategy of Tymlos first and Evenity as a backup.

Maybe I'm misreading the original post. But if she's already had a dose of Evinity, to change to Tymlos seems to conflict with the posts noting that of one can't follow Evenity with Tymlos.

It would be worth getting a second medical opinion about this from an endocrinologist. And maybe, IF staying on Evenity is a good idea, a different doctor would be willing to work with your insurer to get it covered. There are cases when a patient having adverse effects from a drug the insurer does not cover, cam also be denied coverage to treat or deal with those side effects or any complications. That happened to a friend of mine who ended up in litigation over it. Insurers have a far higher responsibility for drugs they cover and any unintended consequences.

Thank you callalloo. It would be extremely helpful to know if there is documented warnings to not take Tymlos after Evenity. Might help with an appeal. We tried but did not get a referral for a rheumatologist. Didn't try for an endocrinologist. Considering a second opinion or a change of insurance. Learning more each day but unfortunately not fast enough to keep up with all this.