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Financial discussions/tips concerning expensive treatment
Osteoporosis & Bone Health | Last Active: Feb 14 6:46pm | Replies (64)Comment receiving replies
@katwhisperer -Just making sure I understand you. So those were the prices your commercial insurance would have charged you , but instead you had assist from Radius for most of that year with having to pay the $2700/month the remainder -- How many months did Radius have a coupon that covered the cost for you, or was it till they paid out a certain amount and then that was it? Can I assume that Radius is the system Tymlos has to set up to help patients, or does it also cover Forteo as well? Thank you so much for your information- cause how much something costs could be a deciding factor in which medication to go with. I think the dr's don't really get that!! Thanks again and wishing you the best as you attempt to get the better treatment for the second year!
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Radius is the maker of Tymlos. Forteo has their own program. I'm on Tymlos, so can only speak to that.
Their Patient Savings Card comes pre-loaded with a set $ amount valid for 1 year. (It offered about 7k in 2023, I think.) Once you hit that cap, no more $ is available that yr.
Everyone hits the cap at diff times: depends upon your pharmacy benefits.
Example: mine requires I meet 3k deductible before insurance pays anything. So I paid full retail price for Tymlos until I reached 3k deductible, then insurance kicked in and I paid 25% after that (around 700/month). The pharmacy applied whatever money I owed each month AFTER insurance processed my claim to my Radius savings card. The savings card zeroed out in Aug. I now pay out of pocket (700/month) for rest of 2023.
Year 2 is the issue. Radius doesn't promise a 2nd card. Fingers crossed, they offer it. But I feel like Plan B should estimate the costs for year 2 without it, just in case.
(I hope all the above makes sense?)
Lower income folks can get Tymlos free - your doctor's office may be very helpful in uncovering these programs. It's just that many people who live alone, (eligibility is usually more generous for bigger households) or those who earn just enough to cover bills without govt help may not qualify.