Just getting started…

Posted by marianq @marianq, Sep 27 9:09am

Good morning. I was just diagnosed with osteoporosis so I’m a bit overwhelmed. My endocrinologist suggested a few medication treatments for me based on my overall medical situation.
One medication that was covered by my Medicare Part D prescription insurer is Tymlos – tier 5 in my plan (never heard of tier 5!). I got a script for this and cost is $584 a month – which I really cannot afford. Manuf drug coupon says doesn’t cover Medicare due to gov’t regulations. Anyone else dealing with this? Any suggestions?
The other possible medications doctor suggested were Evenity or Forteo. Neither are covered currently in my plan however doctor could request a prior authorization to be added to my formulary list. But even if she got one approved, don’t you think these will be even more expensive?? Should I try getting a script for one of these – assuming I could get PA approved?

I don’t want to get on a soapbox here but why are seniors on Medicare penalized by drug companies or why do govt regulations not allow Medicare use these coupons. I probably won’t qualify for “help” but doesn’t mean I can afford. Thanks so much listening. Just looking for any advice.

@marianq, I'm sorry to hear of your diagnosis. I just received this email from AARP today about the high cost of drugs:

Possible vote this week?
Call 1-844-259-9352
And tell Congress to lower drug prices!

We’ve said it before, and we’ll say it again: medications can’t work if people can’t afford them — and right now, too many Americans are being forced to choose between paying for medicine or putting food on the table.

Last week, our community showed up and made waves. Over 13,000 people called Congress to make it known that we won’t stand for unfair drug prices anymore.

But our work isn’t done yet. Congress could be voting THIS week. There’s still time to beat our goal and tell Congress that there is only one acceptable option: vote to allow Medicare to negotiate lower drug prices. Let’s make sure that every lawmaker hears our demands to lower Rx prices!

Dial 1-844-259-9352 NOW
We’ll connect you to your lawmaker.
Tell them: It’s time to lower drug prices.
Prices are over 3x higher in the U.S. than in other countries for the SAME medicine. But Congress is considering a critical proposal that would FINALLY allow Medicare to negotiate lower drug prices. That would help save Medicare hundreds of billions of dollars — AND help lower costs for everyone.

What are we up against? Big Pharma, who is desperately trying to protect its billions in profits. Even during the pandemic, drug companies increased the price of over 1,000 drugs, including those for chronic conditions people over age 50 depend on. Now, they’re spending millions to push misleading claims to scare lawmakers from passing Medicare negotiation into law.

That's why we need you in this fight. Make the call before Congress votes and help drive 5,000 more calls TODAY. Tell Congress it’s time to lower drug prices, NOW.
Dial 1-844-259-9352 to call Congress.
We’ll connect you to your lawmaker and give you a script to guide your call.
Our week of action might be over, but the work isn’t done. We can’t thank you enough for the hard work you’ve put into this fight already.

Thank you,

— The AARP Grassroots Advocacy team

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Thanks, AARP Grassroots Advocacy Team. I’ll call 1st thing tmrw morning.

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Good evening @marianq, I don't think I have had a chance to welcome you to Connect. Osteoporosis is one of the "aging" conditions that seems to wake everyone up. I know there are lots of not-so-positive feelings about the rising cost of medications, especially new ones like Tymlos and Evenity. Rather than dive in head first, perhaps it is best to see what might help. Do you have a Rx plan? Mine is through AARP with an inclusive pharmacy.

Two years ago, after severe reactions to biphosphonates, I was informed that there were only two options for me, Tymlos and Forteo and that they were expensive. With help from Amgen, the manufacturer and my Rx folks, I was able to manage the cost with the gaps and the end runs. I chose Tymlos because of the conversations I had with their medical experts and the fact that it did not have to be in a refrigerator all the time. I was traveling a lot and didn't know if I could manage the storage demands or the cost.

There are supplements to be found and your Rx folks should be able to help you. After considering all of the highs and lows and gaps I ended up paying about $140 a month for Tymlos when averaged over the year. ( If you have a first of the year deductible that might hit pretty hard in January.)

I have also read on Connect that similar arrangements can be made for Evenity.

May you have peace and ease.
Chris

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Thank you so much, Chris. If I could work something like that, I could afford it with all my other medications. May I ask a few clarifying questions?
– RX Folks: Is that your insurance folks thru AARP?
– “I was able to manage the cost with the gaps and the end runs”. Not sure I understand this? Could you clarify?

Do you recommend I call the manuf and ask what assistance that might be able to give me?

The other thing I was thinking of during Medicare Open Enrollment (starting Oct 15th through Dec 7th), I would see what insurance plan might help and look to switch to this insurer for 2022.

Thanks again, Chris.
If anyone has additional suggestions, please respond. I’m open to anything. Have a wonderful day.

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@marianq

Thank you so much, Chris. If I could work something like that, I could afford it with all my other medications. May I ask a few clarifying questions?
– RX Folks: Is that your insurance folks thru AARP?
– “I was able to manage the cost with the gaps and the end runs”. Not sure I understand this? Could you clarify?

Do you recommend I call the manuf and ask what assistance that might be able to give me?

The other thing I was thinking of during Medicare Open Enrollment (starting Oct 15th through Dec 7th), I would see what insurance plan might help and look to switch to this insurer for 2022.

Thanks again, Chris.
If anyone has additional suggestions, please respond. I’m open to anything. Have a wonderful day.

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@marianq I have a Medicare Advantage plan from Minnesota UCare that I really like. My everyday blood pressure drugs are zero copay but then I am paying about $200/month for the plan. There are a few suggestions for trying to wade through the choices on Medicare.Gov here:

6 tips for choosing Medicare drug coverage: https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage/6-tips-for-choosing-medicare-drug-coverage

If you have a local community seniors center or county office you might give them a call to find out if they have any speakers that are coming in to help seniors understand their options for medicare.

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Welcome, I was in your same boat a year ago. I was not given a choice of drugs but was told an Rx was sent to the Pharmacy.
I was blown away when I saw the bill with our RX sent to the house. Mine for Tymos was $900+ and so far have spent over $2000 for seven months. I had to stop for a while because of side effects but now I am back on to try again at a lower dose and increase slowly as I can tolerate. Also, found out Radius has an assistance program that will pay all costs sent to the house each month if you qualify. It all depends on your income. There is an application online to print off. One page your Dr fills out, rest you fill out, and attach one tax form. But you have to be in touch with Radius so they know that you want assistance. 1-800-910-4610 Radius Assist Patient Assistance Program, this is what I called to find all the facts I needed. I wish you good luck in your decision and good health. Please keep in touch I would be interested in what decisions you make in starting your journey. Stay safe KLH

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@kilh

Welcome, I was in your same boat a year ago. I was not given a choice of drugs but was told an Rx was sent to the Pharmacy.
I was blown away when I saw the bill with our RX sent to the house. Mine for Tymos was $900+ and so far have spent over $2000 for seven months. I had to stop for a while because of side effects but now I am back on to try again at a lower dose and increase slowly as I can tolerate. Also, found out Radius has an assistance program that will pay all costs sent to the house each month if you qualify. It all depends on your income. There is an application online to print off. One page your Dr fills out, rest you fill out, and attach one tax form. But you have to be in touch with Radius so they know that you want assistance. 1-800-910-4610 Radius Assist Patient Assistance Program, this is what I called to find all the facts I needed. I wish you good luck in your decision and good health. Please keep in touch I would be interested in what decisions you make in starting your journey. Stay safe KLH

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I am on the Radius Assist plan for Tymlos. The income cut off is pretty high so you might qualify. Lilly has assistance for Forteo but Amgen has no assistance by the company for Evenity:they refer you to a foundation which is spotty in being able to help.

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@windyshores

I am on the Radius Assist plan for Tymlos. The income cut off is pretty high so you might qualify. Lilly has assistance for Forteo but Amgen has no assistance by the company for Evenity:they refer you to a foundation which is spotty in being able to help.

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Good morning, I have Radius Assist approval but when I stopped I thought it was for good. Never thought the docs would let me start again. I have been approved for 18 months for free to be started in Oct. or Nov. We have not made the final decision as to when it will start since I have two months in the refrigerator. Hope you are well and safe. How are you and Tymos getting along. I am back on 2 clicks for another week then 3 clicks. All seems to be going well.

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@kilh

Welcome, I was in your same boat a year ago. I was not given a choice of drugs but was told an Rx was sent to the Pharmacy.
I was blown away when I saw the bill with our RX sent to the house. Mine for Tymos was $900+ and so far have spent over $2000 for seven months. I had to stop for a while because of side effects but now I am back on to try again at a lower dose and increase slowly as I can tolerate. Also, found out Radius has an assistance program that will pay all costs sent to the house each month if you qualify. It all depends on your income. There is an application online to print off. One page your Dr fills out, rest you fill out, and attach one tax form. But you have to be in touch with Radius so they know that you want assistance. 1-800-910-4610 Radius Assist Patient Assistance Program, this is what I called to find all the facts I needed. I wish you good luck in your decision and good health. Please keep in touch I would be interested in what decisions you make in starting your journey. Stay safe KLH

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KLH, thank you so much for your reply. I will definitely explore all the options available here. I’ve never heard of Radius Assist Program but I’ll absolutely give them a call.

Thank you again. I’ll definitely keep you updated. I am worried about the side effects as well. I’m already disabled with terrible arthritis in many places but I’m going to keep a positive attitude throughout this process.

Have a wonderful day, KLH.

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@windyshores

I am on the Radius Assist plan for Tymlos. The income cut off is pretty high so you might qualify. Lilly has assistance for Forteo but Amgen has no assistance by the company for Evenity:they refer you to a foundation which is spotty in being able to help.

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Thanks Windyshores. Appreciate your input as well. You given me hope that maybe I can get assistance from Radius with income level.

Have a wonderful day. 😁

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@marianq

KLH, thank you so much for your reply. I will definitely explore all the options available here. I’ve never heard of Radius Assist Program but I’ll absolutely give them a call.

Thank you again. I’ll definitely keep you updated. I am worried about the side effects as well. I’m already disabled with terrible arthritis in many places but I’m going to keep a positive attitude throughout this process.

Have a wonderful day, KLH.

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Hi, thanks for the reply. I hope I helped a little. Let me know how you come out. I will keep you in my thoughts. KLH

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@kilh

Good morning, I have Radius Assist approval but when I stopped I thought it was for good. Never thought the docs would let me start again. I have been approved for 18 months for free to be started in Oct. or Nov. We have not made the final decision as to when it will start since I have two months in the refrigerator. Hope you are well and safe. How are you and Tymos getting along. I am back on 2 clicks for another week then 3 clicks. All seems to be going well.

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The ASSIST program is still there for you. No need for docs to get involved other than to make sure Rx is still current. Call Tymlos support and the pharmacy you dealt with. I stopped and started and my ASSIST was still available without me doing anything other than calling the pharmacy.

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