Tymlos and Medicare Part D drug coverage

I don’t have information about Medicare Part D. However, I thought I’d just mention that I’m on a Facebook Tymlos group where I’ve learned that Tymlos has helped subsidized the cost for some who can’t otherwise afford it.

Wellcare dropped Tymlos last year, so no, it's not covered. I had to switch from Wellcare to someone else. Blue Cross is a possibility. Open Enrollment begins in October, so you can shop for a new Part D plan for 2027.

There is a copay benefit card available from the manufacturer, but if you're on Medicare, you're not eligible to use it.

Please do not accept the Tymlos denial from WellCare. A Medicare patient can appeal a denial all the way to the
Office Of Medicare Claims and Appeals that I did and won. The process is arduous but worth it. It took me 9 months to win my Appeal and I started Tymlos in July of this year. I have detailed the entire appeal process in a previous post so you can search this forum’s past posts and find my post by entering Tymlos and United Health CareDenial. It is correct that Medicare recipients are not eligible to receive and use the discount coupon for Tymlos but all Medicare recipients with Part D coverage are protected by law to a limited annual dollar copay of $2100/ for all Category 5 Catastrophic Drugs. This is financially life saving since Tymlos costs over $7000/ month! Persistence in appealing an insurance denial not only can benefit you but others by building a database within Medicare demonstrating the statistical denial incidence rate for each of the Medicare Advantage Insurance programs. Fight for what you need to stay healthy. Take care.

If your health plan is through work, ask if they participate with Prudent Rx. 1-800-578-4403. Call anyway. I am on Medicare, but my supplemental plan is through my work's retirement plan. They partner with Prudent Rx, so my Tymlos is free, no copay and delivered by CVS.

I also have WellCare Part D. I was denied Tymlos and yes it is non-formulary. My doctor's office insurance department appealed the denial and we won. So I started the injections immediately. What did help my case was the fact that I had failed two previous treatments, Boniva and Evenity.

@cathyf31 That is great! Sometimes you can fight the system.

@njx58 Sadly, we shouldn't have to fight the system in order to get the medications that our doctors have deemed necessary. 😞