Connect
Tymlos Rejected by Insurance- now what?
Yesterday my endocrinologist recommended that I start Tymlos since my spine is at -3.2. I have severe allergic reactions to most medications because of MCAS and can therefore not take infusions. My insurance will only pay for Reclast or Prolia. Has anyone else had this experience that the insurance refuses to pay for Tymlos? Have you fought this and succeeded? I would be grateful for any advice.
Like
Helpful
HugInterested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.
Connect
Talk to your endo about research organizations who help with can help with drug costs and clinical trials.
Mayo, NYP , NYU Mount Sinai (last 3 in NYC) about hooking up with org's / fdrug co who can help with drug costs.
https://tymlos.com/hcp/resources/
Get support for
access and savings
Get details on financial assistance,
coverage, specialty pharmacies,
and more.
-
Like -
Helpful -
Hug
2 ReactionsSorry to hear this. Is your doctor willing to appeal the decision? The pharmacy associated with my rheumatology dept successfully appealed my insurance's rejection of Evenity. The pharmacist worked with the Evenity rep to do that. If no one is willing to do that for you, then you may need to research other insurance companies that cover Tymlos. Good luck!
-
Like -
Helpful -
Hug
2 Reactionsor other health facilities and doctors .@roisin11
@roisin11
My doctor is quite upset about this and wants to send a letter. But yesterday I spent almost two hours talking to various people who gave me the run around without getting an email address or physical address my doctor could send a letter to! It was enormously frustrating.
-
Like -
Helpful -
Hug
1 Reaction@flowers62 they have to inform you in writing. Call back and ask they provide the written denial, and the information on how to appeal in writing like they re supposed to. There is a procedure for appeal.
The other thing is to check your drug formulary. Is Tymlos on there?
-
Like -
Helpful -
Hug
2 ReactionsThe TYMLOS site has 3 templates for prior authorization, proving medical necessity, etc. on its website. I believe you have to click on a tab that says something like "for health professionals" or something. Let me know if you need help finding it. I will try to check back!
Edited to add link: https://www.tymlos.com/hcp/resources/
-
Like -
Helpful -
Hug
1 ReactionThank you so much!
-
Like -
Helpful -
Hug
1 ReactionI have not had to fight for TYMLOS, but years ago, I had to fight for a surgery.
I didn't stand much of a chance on my own, but my doctor went to bat for me, showed the pros of having the surgery and the cons of not. I had the surgery.
I think you have the right to appeal. Your doctor should help you with this. Please ask him to but, don't delay. Your doctor works for you. You hired him to guard your health. This is his job and I'm sure he takes his job seriously. There may be a limited time to appeal so get on it ASAP. If you take the TYMLOS, it could prevent any fractures or breaks that could cause you a hospital stay, surgery, rehab, etc. TYMLOS is expensive but so are the complications of not taking it.
Keep that letter of denial though......you may need it down the road. Let us know how that goes.
I hope you get the medication you need.
Which brings me to the question of why do we pay for insurance, if we can't count on it when we need it?
-
Like -
Helpful -
Hug
1 Reaction