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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i have medicare advantage and my ra dr wants me to take rinvaq and he put in for approval he also wants me to eventity which he put in for also. i am not sure i am going to take either. he says to me no matter what i take has side effets but the outcome is worth it not sure about that, will depend on the price i have to pay.
I have regular Medicare . I don’t take Tymlos but I take Forteo and that cost 4,500 a month , I called Medicare and yes they helped pay on it but still I would have to pay nearly 2,000 and that’s way out of my budget so I called Lilly Cares that will give a card that all you would have to pay is 5.00 a month but only help with commercial insurance but they told me to call RX advocates and they helped me get it through Lilly Cares for 17.00 four months supply . So it might help you to try them . Hope I’ve helped . Good luck, Janie
If you have regular Medicare, you also must have a drug plan, Part D. What you need to do is check the formulary of your drug plan or phone them. Unless Tymlos is injected, and if so, it should be covered by regular Medicare. Your doc should know if its covered or not.
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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.
Thank you so much
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.
I accidentally hit send before I explained what I meant by "getting better," From what I have been told, in 2024 I will no longer have to pay the 5% catastrophic copay after getting out of the donut hole (which in effect caps my payments at something like $8000 in 2024?). And supposedly there will be a cap on Part D out of pocket cost in 2025. Caveat: I may not be right, and even if I am (1) the rules could change, and (2) insurance companies may react by dropping some of the more expensive drugs from their formulates. (I saw that with Stelara when Medicare stopped covering under Part D – based on the criteria that you COULD inject at home so no longer provided coverage if you chose to use an infusion center.)
… the 2025 cap is $2000.
… I'm having a hard time today! In my Stelara example I meant that Medicare stopped covering Stelara under Part B (not D) when you chose an infusion center rather than at home injection.
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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