Comparing the Anabolic Osteoporosis Medications: Tymlos and Forteo
For those diagnosed with severe osteoporosis, particularly in postmenopausal women and men at high risk of fractures, anabolic medications are often a necessary and effective treatment. Tymlos (abaloparatide) and Forteo (teriparatide) are two such agents that work by stimulating new bone formation. Both are administered via daily subcutaneous injections, with treatment typically limited to a two-year period due to potential safety concerns.
While Tymlos and Forteo are similar in their function, they are distinct pharmaceuticals. Tymlos is a synthetic analog of parathyroid hormone-related protein (PTHrP), while Forteo is a synthetic form of the human parathyroid hormone (PTH). These differences in their molecular structure lead to slight variations in their clinical profiles, including fracture reduction and side effects.
Cost Breakdown: Tymlos vs. Forteo
Historically, the list price for Tymlos was significantly lower than Forteo, giving it a competitive edge in the osteoporosis market. However, with the arrival of generic teriparatide, the cost landscape has become more complex. Here is a breakdown of the price factors:
- Brand-Name Forteo: Without insurance, the brand-name Forteo is extremely expensive, with prices typically exceeding $5,000 per pen for a 28-day supply.
- Generic Forteo (Teriparatide): Since Forteo’s patent expired, generic versions of teriparatide have become available. The retail price for generic teriparatide can vary significantly by pharmacy and can sometimes even cost more than the brand name without discounts. However, coupons and assistance can drastically lower the cost, with some discounted prices as low as around $1,219 per pen as of 2025.
- Tymlos (Abaloparatide): As of 2025, Tymlos remains a brand-name drug with no generic equivalent available. Retail prices without insurance can be substantial, with some pharmacies listing monthly supplies for thousands of dollars.
The Role of Insurance Coverage
For most patients, the out-of-pocket cost is dictated by their insurance plan, not the retail price. Coverage for both drugs is common but not guaranteed and often comes with stipulations:
- Commercial Insurance: Most commercial plans cover both Tymlos and Forteo, though they are often placed on higher formulary tiers, resulting in higher copayments or coinsurance. Prior authorization is frequently required, where the insurance company must approve the prescription based on the doctor’s medical justification.
- Medicare Part D: Medicare Part D plans may cover Tymlos and teriparatide, but a patient's out-of-pocket costs vary based on their specific plan. Starting in 2025, the Medicare Part D out-of-pocket maximum is capped at $2,000, which can significantly benefit those needing expensive medications like these.
Comparing Efficacy and Safety
While cost is a major consideration, the choice between these medications also depends on their clinical performance. The ACTIVE trial showed that Tymlos was more effective at reducing certain major osteoporotic fractures compared to Forteo. A meta-analysis published in 2024 also found that Tymlos exhibited a significantly lower occurrence of both hip and nonvertebral fractures compared to teriparatide in a real-world setting.
It is also important to note that both drugs carry a 'black box' warning for osteosarcoma risk, limiting their use to a maximum of two years in a patient's lifetime. Differences in side effect profiles also exist, with Tymlos users reporting slightly lower rates of hypercalcemia compared to Forteo users in a clinical study.
Finding Financial Assistance
Given the high cost of these medications, manufacturer and independent assistance programs are crucial for affordability. Both Radius Health (for Tymlos) and Eli Lilly (for Forteo) offer comprehensive support programs:
- For Tymlos: Radius Assist offers a patient assistance program for uninsured or underinsured patients and a savings card for commercially insured patients, which could reduce monthly costs to as little as $0 for eligible individuals.
- For Forteo: Eli Lilly offers a savings card for commercially insured patients and the Lilly Cares Foundation Patient Assistance Program for those with financial needs who are not enrolled in government-funded healthcare programs.
Patients can also explore programs from third-party organizations like Simplefill or use discount cards like those offered by GoodRx to find savings on generic teriparatide.
Tymlos vs. Forteo Comparison Table
| Feature | Tymlos (Abaloparatide) | Forteo (Teriparatide) |
|---|---|---|
| Active Ingredient | Abaloparatide | Teriparatide |
| Availability | Brand-name only | Brand-name and generic versions |
| List Price (Without Insurance) | Typically lower than brand-name Forteo | Very high, but varies; generic is less expensive |
| Insurance Coverage | High commercial coverage, good Medicare Part D coverage; requires prior authorization | High commercial coverage, good Medicare Part D coverage; requires prior authorization |
| Patient Assistance | Radius Assist for eligible uninsured/underinsured; savings card for commercial insurance | Lilly Cares for eligible uninsured/underinsured; savings card for commercial insurance |
| Key Efficacy Difference | Some studies show superior reduction in major osteoporotic fractures | Standard-of-care anabolic; may be more effective for vertebral fracture reduction |
| Daily Administration | Subcutaneous injection | Subcutaneous injection |
Conclusion: Making an Informed Decision
So, is Tymlos cheaper than Forteo? Historically, yes, but the answer is not as simple as it once was. With the availability of generic teriparatide and a patient's specific insurance coverage and eligibility for assistance programs, the out-of-pocket cost can fluctuate significantly. Patients on commercial insurance may find substantial savings through manufacturer savings cards for Tymlos, while those eligible for patient assistance programs may receive either medication at a low or no cost. With the new Medicare Part D cap in 2025, many patients will have a much clearer financial picture regardless of which drug they choose.
Ultimately, the choice between Tymlos and Forteo is a complex medical and financial decision that should be made in consultation with a healthcare provider. Discussing the clinical merits, potential side effects, and all available financial assistance options will ensure the most effective and affordable treatment plan.
