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Tymlos - how does ANYONE on Medicare pay for this drug?
I have been 'beating the bushes' to find help. I make just over the financial cut-off line for Forteo and Tymlos is worse. Their financial 'cutoff' is 13,000 and change (you can't make more than that per year!!!)
I am disgusted. I have reached out to every possible financial support organization and nothing works. I am not rich but if I pay what they want me to pay I will lose my condo!
I've tried the PAN foundation and all others like it. Social Security's rule is that you not make more than 20k a year to get help.
I have severe osteoporosis. I can't take bisphosenates. I am really angry at these greedy drug companies.
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HugInterested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.
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Well, United Healthcare is infamous for its coverage, or lack thereof.
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1 ReactionI am trying also to get funding for tymlos
I have Medicare part d
My osteoporosis is so bad and I keep breaking bones. My walking has now been affected also. My doctor has been trying to help also. How can anyone live making $13,000 with Radious Assist.
Unbelievable. You have to feed your family and have a home? That was shocking to me. And my insurance pays for 3 months at a time. Plus the needles for another $60.
What happens after 3 months or more and you don’t have the money? I am a single 68 year old women? I will take any suggestions
@juliasbeach I don't know if this will help----per google :
Alternative Assistance for Medicare Patients
While the savings card is not an option, other programs are specifically designed for Medicare beneficiaries to help with the cost of TYMLOS:
1. Radius Assist Patient Assistance Program
This program provides TYMLOS at no cost to qualified patients in need, including those who are Medicare beneficiaries.
Eligibility: Based on household income (typically less than 300% of the Federal Poverty Level) and lack of other coverage options.
Duration: Can provide up to 18 to 24 months of therapy.
Contact: Patients can call 1-866-896-5674 for an eligibility prescreening.
tymlos.com
2. Independent Foundations
Non-profit organizations provide grants specifically for Medicare patients with postmenopausal osteoporosis:
PAN Foundation: Offers support for biologically female Medicare patients, including coverage for TYMLOS.
HealthWell Foundation: Provides financial assistance to Medicare patients for postmenopausal osteoporosis medications.
3. Medicare Part D 2026 Caps
Starting in 2026, all Medicare Part D plans have a $2,100 annual out-of-pocket cap for covered medications. Once you spend $2,100 on covered drugs in a calendar year, your plan covers 100% of the remaining costs for the rest of that yearer
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2 Reactions@colleenyoung
Contact the drug company and see if they have an assistance program. My daughter did this for a drug she had to have for her liver. It cut her copay by $2,000 per month.
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1 ReactionI am in the exact same boat with Medicare Part D. I make just over the Tymlos financial cut off for any assistance. I basically had to make the difficult decision, knowing that I would be paying the $2,100 out of pocket max each calendar year to remain on the medication. Sadly, that's means paying for the first pen and a half, before it becomes free for the rest of that calendar year. For me, the gamble was my high chance of side effects and not being able to stay on the medication beyond the first pen or two. That is still yet to be determined. At the end of the day, I could not afford to not pay the big money out of pocket. I had to prioritize my bone health first. At the end of this journey, I am hoping to have as few regrets as possible.
Also, if you have not tried Evenity, you could possibly look into that as it is both an osteoclast and osteoblast and is processed through Part B. Based on your insurance plan, Evenity might be more financially practical.
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2 Reactions@cathyf31
Hi Cathy,
I started my first injection of Tymlos 6 days ago. It’s a tier 5 drug with a PA needed with my Medicare advantage plan. I was very hesitant starting without a PA approval but I did. Well the PA got denied, now my doctor is appealing. I paid $1089 for the first 30 day supply. If appeal is denied I will have to seek assistance. I can’t afford to be self pay. As it is I will be paying $2100 for a 3 quarters of the year. Why the government doesn’t allow the savings programs is beyond me.
Regarding the injections, I am doing ok. I take my injection at 9pm and go to bed and read. I had some nausea last night for the first time. Hopefully that will not happen often.
Good luck
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1 Reaction@diane2154 I paid close to $1,800 for my first pen. Criminal. Just paid $331 for my second. Ugh. Rest will be "free."
@cathyf31
Did you need a prior authorization? I will be in the same boat if the PA gets approved. If not it would be out of pocket and I cannot afford that. I will and can do the $2100 but no more than that.
2026 Medicare Part D, $2,100 cap on prescriptions, you meet that in the first 2-3 months then it’s zero for me the rest of the year for all meds. Look into it with your Medicare professional?
@juliasbeach - my understanding is that teriparatide (generic Forteo) is similar to Tymlos (but not exactly the same, it's an older drug). I have Medicare Part D with a plan from Wellcare Value Script in PA. When I signed up for this year's plan, I noticed that very few plans covered Tymlos but pretty much everyone covered the generic teriparatide. Wellcare approved me for 2 years of use. Yes, I have to pay that $2,100 deductible at the beginning of each year, but after that there is no cost to me. Just wanted to share in case you wanted to consider switching drugs.