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Does anyone have Regular Medicare and know if they pay for Tymlos?

Posted by jdwandmew @jdwandmew, Nov 12, 2023

Does anyone have Regular Medicare and know if they pay for Tymlos? My drug plan doesn't cover it since it's a Tier 5. Thanks.

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dee5 | @dee5 | Nov 13, 2023

Hi
I am on Tymlos. My Medicare prescription plan D covers the cost. Of course, it’s different price at different tiers. I started by paying about $600 in the beginning now at almost end of the year, I am paying $180. Hope this helps.

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2 replies
jdwandmew | @jdwandmew | Nov 13, 2023
In reply to @dee5 "Hi I am on Tymlos. My Medicare prescription plan D covers the cost. Of course, it’s..." + (show)
@dee5

Hi
I am on Tymlos. My Medicare prescription plan D covers the cost. Of course, it’s different price at different tiers. I started by paying about $600 in the beginning now at almost end of the year, I am paying $180. Hope this helps.

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Yes my choices are limited since I'm in such a small county. But I'll be calling them to make sure. Thanks

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hardingv | @hardingv | Nov 14, 2023
In reply to @hardingv "I am also on original Medicare (with a medigap supplemental plan) and have been taking Tymlos...." + (show)
@hardingv

I am also on original Medicare (with a medigap supplemental plan) and have been taking Tymlos. I had to get Part D to cover Tymlos. It is expensive, but getting better.

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I was looking at 2024 Medicare Part D plans today (available for those with original Medicare). Attached is info (including Tymlos costs) on a Wellcare Value plan available in AZ ($0 premium, $400 deductible): yearly costs and cost for drug by stage.

The relatively low yearly drug costs reflect the fact that (1) in 2024 the copay is $0 after you leave the donut hole (i.e, no longer pay catastrophic coverage), and (2) you get out of the donut hole faster because of the 70% brand name credit for drugs like Tymlos while in the donut hole.
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bayhorse | @bayhorse | Nov 15, 2023
In reply to @imay "Medicare itself only pays for medications that are administered in a hospital, like Evenity. Forteo and..." + (show)
@imay

Medicare itself only pays for medications that are administered in a hospital, like Evenity. Forteo and Tymlos are self administered at home, so they are covered under Part D. I am using Tymlos, which is Tier 5 under most plans; I pay 27% of the cost and I didn't see any plans that covered it any better.

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I pay 25 % of the cost on a WellCare Part D policy. Not much better than 27%, but...

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1 reply
bayhorse | @bayhorse | Nov 15, 2023
In reply to @jdwandmew "In know. They've made things very confusing. I don't know what to do. I really don't..." + (show)
@jdwandmew

In know. They've made things very confusing. I don't know what to do. I really don't want Prolia (which is covered) and I really don't even want tymlos but I'd rather have one that at least builds bone of I have to pick. But I don't think the bone is very strong. Ugh!

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For what it's worth (and it might be worth nothing!) a doctor whom I highly respect told me the best course of treatment for someone with severe osteoporosis (me) was to go through the 18-month course of Tymlos and then go to Prolia.

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imay | @imay | Nov 15, 2023
In reply to @bayhorse "I pay 25 % of the cost on a WellCare Part D policy. Not much better..." + (show)
@bayhorse

I pay 25 % of the cost on a WellCare Part D policy. Not much better than 27%, but...

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Value Care PP? That is what I have and we pay 25% this year and 27% next year, which I think applies to all Tier 5 drugs.

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rajmayo22 | @rajmayo22 | Nov 16, 2023

Starting 2024, my insurance Aetna is switching to SilverScript Medicare Part D for federal retirees. Tymlos, Class 5 drug in Formulary is not covered. Annual cost is $36,000. Since I am already under treatment, I may get Tymlos for the remaining period of 8 months in 2024 at no cost to me. I paln to check with Radius Labs if I would be eligible for assistance. If not I will discontinue after 17 months of treatment which has been proved as beneficial after 12 months of taking the med.

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1 reply
cat714 | @cat714 | Nov 17, 2023
In reply to @rajmayo22 "Starting 2024, my insurance Aetna is switching to SilverScript Medicare Part D for federal retirees. Tymlos,..." + (show)
@rajmayo22

Starting 2024, my insurance Aetna is switching to SilverScript Medicare Part D for federal retirees. Tymlos, Class 5 drug in Formulary is not covered. Annual cost is $36,000. Since I am already under treatment, I may get Tymlos for the remaining period of 8 months in 2024 at no cost to me. I paln to check with Radius Labs if I would be eligible for assistance. If not I will discontinue after 17 months of treatment which has been proved as beneficial after 12 months of taking the med.

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Is the radius labs the advocate for tylmos assistance? Thanks

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1 reply
susanfalcon52 | @susanfalcon52 | Nov 17, 2023

I’m on Traditional Medicare and I’m getting Evenity. Part B pays 100% of the cost because I get it in an infusion center. I realize that Evenity is not Tymlos. Just a thought.

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rajmayo22 | @rajmayo22 | Nov 17, 2023
In reply to @cat714 "Is the radius labs the advocate for tylmos assistance? Thanks" + (show)
@cat714

Is the radius labs the advocate for tylmos assistance? Thanks

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Will let you know after I talk to them

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