What Osteoporosis medicines are likely to be approved

If you're in the U.S., you either have original Medicare and a stand alone Rx plan, or Medicare Advantage. I only know about the stand alone prescription plans. If you have one of these and didn't change plans by December 7th, you'll have the same plan next year. Log into Medicare.gov and click on 2026 Rx plans (Part D). Find the plan you will have for next year (the one you have now if you didn't change plans). You will have the option to put in a Medication List. Enter the medication you would like to take, and see if it is covered. You will be able to see the monthly premium and the drug cost. If the drug isn't covered, delete it from your list and enter another one, and see if that is covered. Maybe someone else can address what to do if you have Medicare Advantage.

@barb3 thank you

stolktzs1956, you might call https://therxadvocates.com/ to find out if your income is low enough to qualify for help. While it seems backward to choose the medication based on insurance instead of which would be best for your body, but that's how it ends up many times. I've heard that it is fairly easy to qualify for Forteo with RX Advocates. Speak with an associate and they will be able to tell you what you might qualify for.
I hope you can get the medications you need.

Another source of info on obtaining the best pricing is BlinkRx.

@stoltzks1956 If the medication is covered by your Part D plan, then the most you will pay in 2026 is $2100 for the year. If it's teriparatide (Forteo generic) or Tymlos (no generic), you'll definitely reach that cap.

If you have having monthly Evenity injections at the doctor's office, that will likely be a Part B medical claim, not a Part D prescription cost.

I'm on original Medicare with a separate drug plan. The insurance companies always try for the "cheapest" drug for treatment rather than what is best for the patient. Initially I was denied and my doctor appealed. She works in a large medical environment and they have a dedicated team to handle appeals. I have a gastric condition and cannot tolerate fosamax which was the drug insurance approved. We obtained supporting documentation from my gastro doctor and then Tymlos was approved. I also have extensive dental restorations and did not care to have my teeth fall out! If you have certain underlying conditions or prior non-trauma fractures, you should not have a problem getting approved but you may need to go thru the appeals process, as I did. My appeal took only 2 weeks. I'm currently on Tymlos for 3 months. Good luck in the process and don't be discouraged by temporary roadblocks.

@njx58
Yes, if you get a Medicare Part D drug plan that includes the medication, your out-of-pocket cost for your drugs is limited to $2100 for the calendar year. But the cost of Part D plans that include Tymlos is considerably higher than other plans. For example in my area (central Ohio), there was only one plan this year that included Tymlos, and it was $123/month (this as compared to $7/month for a plan that included all my other drugs but not Tymlos). So the $2100 cap helps but doesn't necessarily tell your total cost.

If you’re having trouble navigating the system, I’d start by speaking with someone at medicare.gov 1-800-MEDICARE.

If you’re still having trouble Medicare now pays a portion of Medicare advocacy programs.

From AI:

Types of Medicare Advocates
State Health Insurance Assistance Programs (SHIPs): Federally funded programs offering free, unbiased counseling via phone or in-person to understand Medicare options. Find your local office at shiptacenter.org.

Non-Profit Organizations: Groups like the Center for Medicare Advocacy (CMA) provide legal help, policy advocacy, and education, focusing on systemic issues and individual rights.

Private Patient Advocates: Independent professionals who charge hourly fees (e.g., $100-$500/hr) for personalized help with appointments, claims, and navigating the system, with some services potentially covered by Medicare.

I don’t think I can mention specific companies here but I wish I was able. Be careful with private companies. One company I researched for a friend with ALS seemed very promising . Then I read on Reddit about a person who was charged (Medicare actually paid 80%) $1200 to get one set of medical records from one doctor! There are definitely, I believe, companies that will abuse the system so ask lots of questions before you become a client.

My experience has been that 'SHIPS' can be either really helpful or not. Depends on the state and the resources it puts into this program. But it is a good first effort.

There are many programs for help with medical assistance if your income is below certain thresholds. Medicaid would likely be the most helpful but there are also other income-based programs available for Medicare enrollees. But you have to learn about them.

The place I would go to for counseling assistance if I became stymied is the Medicare Rights Center 800-333-4114, which does not charge a fee like a private advocacy business. Best of luck.

Thank you so much. When I went through chemo this year the Pan foundation helped me. Just didn’t know a foundation that would help with Osteoporosis drugs