@mspatart The paperwork wasn't too bad. Together with Tymlos is very helpful. Have you talked with them? You should have a personal representative there.

I was on this same journey trying to get my Medicare HMO provider to help pay for Tymlos. Concurrently, I tried to get the Tymlos manufacturer to provide it to me at a reduced cost. Since I did not qualify for assistance from the Tymlos manufacturer, I had to pursue the insurance path.

From my experience, if the direct route does not work out ( but I hope it does!), it would be good to understand exactly what your insurance provider is saying - is it not covered at all, or is it covered but you have to provide justification?

My endocrinologist submitted several appeals to my HMO on my behalf to allow the drug to be used. When we got through that hurdle, my initial cost of Tymlos $920 a month. But I recently reached the threshold of max-out of pocket, so my cost going forward will be $130 a month, till the end of the year. Jan 2024 it will reset again until I reach the max out of pocket threshold.

Please keep us posted on your journey!

When my medication was approved, I received a call from Walgreens Alliance telling me that my co-pay was $3,000 for the first three months. I nearly fainted.
Then I remembered that my doctor had dowloaded a manufacturer’s savings coupon, and gave them the Rx group, Rx Bin and Rx id numbers printed on the coupon. Two hours later, they called me back to tell me that the coupon had covered the full $3,000 of my co-pay!
Ask your doctor if he or she can get a coupon for you.