Evenity….stopped after the first set of injections…

@sedrake51 I asked if you had taken strontium because it makes bones look denser than they are on DEXA. Great that you had those improvements without meds AND without strontium.

Your scores are pretty good so I am wondering why you had the forearm and femur fractures. (What is side-stepping?) What do you think? (The ones from the accident are understandable. I had a T12 fracture from an accident too!) Also why is your forearm so much worse than other sites? Is that -4.3 reliable?

fili123, I'm currently investigating Forteo/Teriparatide/Tymlos costs for Medicare Part D plans in my area (New England). Both Forteo & Tymlos are brand drugs and under 2024 Part D drug changes (thanks to the Inflation Reduction Act) actually cost approximately $3-3500 for the full year. The costs fall in the first 3 months (Jan-Mar) then there is no monthly cost Apr-Dec.

Teriparatide (generic Forteo) actually costs more, approximately 7-8000 your out-of-pocket for the full year. If understand the medicare drug changes correctly, generic drugs are less cost overall, but spread over all 12 months. It's weird right? We're all conditioned to go to generic drugs for cost savings.

For more information for your area go to Medicare.gov.

2024 - Changes to Inflation Reduction Act

Learn more about coverage phases.
What you pay for drugs in a year depends on what coverage phase you’re in. Once you meet your “deductible,” a drug’s cost could vary in each coverage phase. You’ll start a new coverage phase once your spending for drugs has reached a certain amount.

Cost after deductible (also called "initial coverage")
Cost after deductible (also called "initial coverage") - You’ll pay a percentage of the plan’s cost for covered drugs. Once you and your plan spend $5,030 combined on drugs (including deductible), you’re in the coverage gap.

Coverage gap (also called "donut hole")
Coverage gap (also called "donut hole") - You’re in this phase if you and your plan spend $5,030 on drugs. During this phase, your plan doesn’t pay for your drugs. You’ll pay no more than 25% of the cost for brand-name drugs and generic drugs until you spend $8,000.

Cost after coverage gap (also called "catastrophic coverage")
Cost after coverage gap (also called "catastrophic coverage") - You’ll reach this phase if your drug costs reach $8,000 during the year (this includes certain payments made by other people or entities on your behalf, including Medicare’s Extra Help program). You won’t have to pay a copayment or coinsurance for covered Part D drugs for the rest of the calendar year.

Thank u! It’s amazing how these companies offer those with Commercial Ins discount cards with 0-$4 co pays but not available to anyone with Government Ins; Medicare, etc.
I actually called both Lilly and the other one and was told it’s against the law to offer these discounts to Govt insured.

Good grief, how can people afford these outrageous drug prices 😔!

Call the companies for their assistance programs. These are available to people over 65 unlike coupons.

fili123, which companies did you speak with? That was my next set of research. I was going to look into Lilly Cares, RX Advocate, and Arrayrxcard (CT state drug pgm).

I agree with you re Medicare exclusion. Most Medicare people are on a fixed, lower income and need the additional drug support. Interesting they state it's against the law to include government ensured. Maybe because Medicare tries to negotiate best cost? I did read on Medicare.gov that you hit catastrophic phase at $2000 in 2024 vs the $8000 in 2023. Again, as result of the Inflation Reduction Act Biden signed into law. Keep your fingers crossed this actually happens.

Hi windyshores. I'm looking into Forteo and Tymlos costs. Who would cover Tymlos? I saw the coupon card for Tymlos but people on Medicare are excluded.

There's Lilly Cares for Forteo and Radius Assist for Tymlos. Both of which, if accept Medicare Part D, require your total household income to be equal to or less than 300% of poverty level.

Yes (unfortunately?) I made that income level! But my Medicare Advantage coverage wasn't too bad once I ran out of the free 18 month supply. I hope you can get coverage!

Since this Discussion started with Evenity I thought I'd answer the questions that have come up regarding Medicare. I have Traditional Medicare and do not have a Medicare Advantage Plan.
Evenity must be administered at an infusion center or hospital/clinic. For that reason, Evenity can be billed as Medicare Part B (outpatient such as going to your doctor's office) and not as Part D that you get from the pharmacy and that you administer to yourself. I don't know how it works with other medications such as Prolia or Tymlos.

It can be really difficult to figure what is covered, what your co-pay will be, and what is not covered. It's best to call or write your insurance company. I do know that if Medicare has approved coverage of a medication that all Medicare Advantage programs and Part D prescription plans must include the medication in their coverage. However, the costs will differ between plans. That's where it can get confusing.

Just an FYI. I was introduced to GoodRX by a pharmacist. I always check GoodRX when I get a new prescription because sometimes their co-pay is less than my Part D prescription plan. It's so crazy.

Tymlos is administered at home, by us, and is supplied by a specialty pharmacy. So not Part B.