Does Medicare part D cover Tymlos?

Do you have traditional or advantage Medicare? Do you have a supplemental in addition to part D? How is your physician/medical group responding to this? It is great that you are here getting info and help from those who may have tackled this before. In the meantime have you contacted the company that makes tymlos to see if the have a patient assistance program. Some doctor s offices have a person who can give you guidances. I am sure you will get lots of help here.

It will depend on your Part D plan. There are many to choose from. They differ in their formularies (the drugs they cover.). So you would want to choose a plan that covers Tymlos (or its generic). It's hard to find out what you would pay until your doctor actually orders the prescription. You can always refuse it if it turns out to be more than you can afford. You can always try to get an answer from your insurance co. or the pharmacy that you would use before the prescription is ordered which in my view is how it SHOULD work but it may not represent the actual cost. From what I have seen and read, the patient assistance program that drug companies offers only applies to commercial insurance, not Medicare or Medicare Advantage. I have a Medicare Advantage plan so do not need (and couldn't buy if I wanted to) a separate Plan D as MA includes drug coverage. But MAs also have their own formularies so you would still need to check if your MA plan, should you go that route, covers Tymlos. Personally, I am just starting teriparatide, the generic of Forteo, which is similar to Tymlos. It is the only anabolic my MA drug plan covers. (Evenity, the other anabolic, is covered under Medicare Part B.) My cost is $100 for a 3-month supply, so that's only $33 a month.

Thank you

I have traditional Medicare with Part D coverage.
- In 2023 I had a Cigna Part D plan. As others have noted, you have to get a plan that includes Tymlos in its formulary - which the Cigna plan did.
- Cigna gave me a 2 yr prior approval when I started in 2022. In 2023 I paid $405 for a 90 day supply (actually 3 pens x 28 days).
- I had 3 pens left in the "2 yr" (24 pen) RX when I changed to a Wellcare plan in 2024.
- Although Tymlos was in the Wellcare formulary, they wouldn't approve the last 3 pens, with a gobbledygook response that I had already gotten enough.

The Part D rules have been changing. In 2024 you no longer paid anything once you reached what used to be the catastrophic tier. And as I understand it, in 2025 there will generally be a cap of $2,000 on what you pay. I'm afraid the net effect will be that insurance companies start dropping more expensive drugs like Tymlos from their formulates, but maybe not.

Personally I no longer have that issue since I followed Tymlos with a Reclast infusion, which is fully covered under Part B (+ my Physicians Mutual supplement). All I can say is hopefully you can still find reasonable Tymlos coverage, but be sure to ask lots of questions about how things will play out in the future (v just past experience). Good luck .

Thank you !
So you’re on reclast now
Did you finish the 2 years on Tymlos before going to reclast ?
How’s it going on reclast ?
Side effects?
Improvement on dexa ?

I think my response disappeared. Try again.
I was short only 1 pen since my original endo gave me two to cover when I was having trouble with my RX. And my current endo said it wasn't worth appealing since Tymlos wasn't as effective towards the end anyway
Dexa results were good.
So I went to Reclast a month early. I followed hydration and Tylenol suggestions, had a 30 min infusion, and had only a few days of flu like symptoms. I was particularly concerned about uveitis because I have a retinal condition that makes me more susceptible, but fortunately it was not a proble. The endo may do a second Reclast next year, depending on test results at the time.
So I am thankful I am doing well so far

Thanks so very much for you information

My Plan D insurance finally approved Tymlos (after initial denial). However it's $1300 monthly! Thankfully it's now close to year end, so most likely 3 months @$1300 and then in 2025 I'll be grateful for the drug cap!

When available, be sure to check your plan's formulary for next year to confirm it still includes Tymlos. I was talking to the agent we used and she agreed that with the $2000 cap some plans are going to drop more expensive drugs

The health insurance companies are sure to restructure their 2025 plans to adapt to the new caps.

Possible strategies = increased premiums; tiered premium structures with lower premiums offering fewer drug options; restricting drug coverage; coinsurance adjustments; more drug tiers; ramping up prior authorizations and step therapy protocols.

I've been so relieved to get the Tymlos approval and to also have the 2025 cap, I hadn't thought about the insurance companies 2025 response. So thanks for alerting us. Insurance companies will restructure plans so they don't lose profits. So we all need to allot enough time so that we can analyze the new scenario and choose wisely.