Medication???

@hopefulheart
Getting another opinion on osteoporosis and possibly taking medication is good. I hope the 2nd consult is helpful for you.

I have a few questions regarding the prescription for Tymlos.

1. What is your age?
2. Do you have Medicare insurance? If yes, is it Original Medicare or is it Medicare Advantage?

I get Evenity at an infusion center. I have Original Medicare and the monthly Evenity injections are covered by Medicare Part B. This means that after I have met my deductible for Medicare Part B which I've already done this year, there is no additional cost to me.

I don't know how Tymlos, Reclast or Prolia are covered by insurance. I do know that if Medicare approves any of these medications and you have Original Medicare or Medicare Advantage, then the medication is approved for coverage. However, the cost to you will vary depending on your insurance plan.

Does this help?

Thanks for your reply
I have private insurance
I’m 63

Find out what your insurance plan covers. Cost is a major consideration. Even with private coverage there may be help for you with RX advocates. It is income based
I really scrambled for the Forteo because I think it is the best drug available. First I got it in Singapore for $1000 a pen. Then I took the generic through GoodRX for $700 a pen. I may go to Colombia for $300 a pen. You might consider taking it every other day. I'm considering alternating with a bisphosphonate. Even $300 a month seems like too much for medication.
I hear good things about Reclast and scary things about Evenity and the heart. I'd stay away from Prolia. Depending on your risk for fractures, Reclast might be a good choice. Easier, certainly. We lose the most bone at your age.
Another consultation should help. Wishing you the best.

Do you also have a supplement plan also known as medigap insurance?

I am in same situation- I’m 67 but not on Medicare because insurance trough hubby who is still working. BCBS Federal will not cover any osteoporosis drugs. Our health system is horrible, preventive care is non existent.

@hopefulheart Insurance is just so hard to figure out. I had BC/BS when I was working and went right to Medicare when I retired at age 67. I had a few back and forth "arguments" with BC/BS about billing but fortunately it usually worked out when the Benefits department where I work got involved in the discussion. The last year I was working (2019) the hospital where I had a D& C (dilation and curetage) did some what I call "creative" billing that they could do. It infuriated me when I got the bills as my deductible was quite high on the private insurance and so I was required to pay all of these costs I'd never seen before in previous years.

The best any of us can do is to keep checking and re-checking with the insurance and with the financial/billing department for the provider.

There's some information about programs that help pay for prescriptions in this conversation: https://connect.mayoclinic.org/discussion/any-leads-on-rx-payment-assistance-for-under-65s/

@hopefulibraian, @hopefulheart, @naturegirl5 ,@reillyg1013 , @gently, @rjd and others.
I LOVE all the info !!!! …. BUT COULD THESE FINANCIAL TIPS PLEASE BE PUT IN THE FINANCIAL THREAD CREATED SPECIFICALLY for that so we can find it easily without having to scour through other places in hopes to find some relevant information concerning this huge DILEMMA!! Thank you soo so very much!!!

Call the Tymlos people and see how they can help you. I don't know the details of how it works, but my husband was relieved with the help we got.

Reclast and Prolia are usually administered in a doctor’s office or infusion center and therefore covered under Medicare part B. Tymlos is a self administered medication so coverage may be available under a part d insurance. It’s likely subject to prior authorization and coverage varies depending on the plan.