Forteo® Medicare Coverage

Forteo®
Chemical name: Teriparatide

Typical dosage: 20mcg

Typical type: Injection1

Forteo® is a prescription medication used in men and post-menopausal women with osteoporosis at high risk of fractures. This medication is currently available as a brand-only medication.

Forteo is used to treat osteoporosis by building healthy bone growth and slowing bone loss for men and post-menopausal women at a high risk of developing fractures.

It is a once daily subcutaneous injection given in the abdomen or thigh with or without food or drink. This injection is stored in the refrigerator at 36-46 °F and must be used directly after being removed from the refrigerator.

Common side effects with this medication include high calcium levels, dizziness, leg cramps, muscle pain and nausea. A serious side effect that can occur is increased risk of bone cancer called osteosarcoma.

Forteo has been proven to increase bone mineral density and reduce the risk of fractures in post-menopausal women, but is also approved for use in men.

Does Medicare cover Forteo?

Yes! 94% of Medicare Advantage plans and Medicare Part D plans cover Forteo.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Forteo.

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Average costs for Forteo with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$835 – $3,940 $811 – $3,940

Additional information

Osteoporosis is a disease where the density and quality of the bones are reduced, which increases the risk of fractures and other complications such as infection and even death.

Forteo promotes growth of new bone to treat osteoporosis, unlike other therapies that may only improve the bone density of current bone. This medication is supplied in a delivery device and must be discarded 28 days after use even if there is medication remaining.

Forteo should not be taken for more than 2 years and should not be used in patients at an increased risk of osteosarcoma.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

 

Written by Hayden Gharibyar, Pharm.D.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Forteo. Retrieved May 2019, from www.goodrx.com/forteo.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.