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Update to insurance denying Evenity.
Spoke to my Dr today. She said she figured insurance would deny Evenity because typically you either have to have had a fracture or a score of -3.0 or below. My spine is -2.7 and hips are -2.0. Insurance wants me to do Prolia first. I told her my issues with Prolia with the rebound effects and increase of spinal fracture after stopping it. I told her I’m 61 if I was in my 80’s then yeah maybe. She said she has patients that have good results with Prolia. Yeah I thought to myself until you stop it. The other choice is Reclast, she said with my issues with Fosomax and Reclast being a biophosonate she thought I’d be hesitant. She said I need to do something. I said I was going to call Evenity and see if I could get financial assistance. She didn’t think I would but said to try. I signed up on the Amgen website that offers the assistance. They gave me $8,000. Which wouldn’t probably cover 4 months of shots. I asked the Dr about Forteo and Tymlos and she said insurance won’t cover those either if they won’t cover Evenity. She said she knows the studies are saying to do anabolic meds first but insurance companies are the issue.
So now I’m not sure what to do. I’m going to call a menopause specialist and talk about a HRT patch. I don’t think it will increase my score but might hold it steady? Or I might go back on Fosomax. When I took it before I had severe pain in my right hip and I wasn’t able to roll over in bed for 2 nights. Then it’d go away. I might just deal with the pain for 2 nights. It didn’t bother me once I was up and walking, just lying down. Or I can try appealing my insurance denial too. Ugh
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Try appealing with the Dr's help. A lot if insurance companies back down once an appeal is filed. FWIW, I've had excellent results on Tymlos.
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2 ReactionsI'm using topical HRT, it has stabilized my bone loss. My bone markers show this. My spine was -3.5.
Spine bone turnover is quicker than other areas.
Maybe consider doing HRT and using a lower dose of Fosomax.
Prevention of Osteoporosis (postmenopausal women): 35 mg once a week or 5 mg once a day.
Maybe the combination would be enough to move things back into osteopenia. And then you could stop the fosamax and just continue the HRT.
I chose the topical HRT and my dose is customized for me. Because i had allergic reaction to estradiol, so I needed a lower dosage, i also wanted lowest dosage possible and use topical becuase of family breast cancer history.
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3 Reactions@oknowwhatpixie
I didn’t realize there was a lower dose of Fosomax. I will definitely ask about that. I was thinking same thing that maybe HRT with Fosomax might be helpful.
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1 ReactionIf the help Amgen would give you covers the first 3/4 months, I would do that. I read a study thst most of the gain is on the first 3 months and in future could possibly be shortened duration of treatment. I can’t provide the link at the moment but if you look up work of Benjamin Leder you might find it.
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1 ReactionI fought the United Health Care (UHC) denials for 9 months and eventually won. I have now been taking Tymlos injections for over a month. I am on Medicare Advantage insurance. The appeal process is arduous but worth it. You can continue to appeal denials all the way to the an Administrative Law Judge within the Office Of Medicare Hearings And Appeals (OMHA). You will encounter many delays but be persistent. I detailed the appeals process in a previous post so if you enter UHC denial of Tymlos in the search option at the top of the forum you may find the post. Good luck.
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5 ReactionsI was thinking the exact same thing as @donnabutcher. Evenity gives great results and do the 3-4 months if you can afford. Your Dr should be able to get you qualified on the forteo or tymlos since you've already been approved on Evenity all anabolics. Many say they cannot tolerate the fosomax (gerd) and that's all it takes usually. You have to work the system as it is sadly, the insurance companies do not have our best interest in mind.
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1 Reaction@paxbar, It just shouldn't be this hard! I'll never understand it and I'm glad you finally got what you need! Gosh.