Forteo: Insurance Change Impact

If you are on Forteo and your insurance changes, you may be concerned about the cost of this medication. Forteo is a brand-name prescription drug that helps increase bone mass in people with osteoporosis. It is a specialty drug, so there may be barriers to coverage depending on your insurance plan. The cost of Forteo without insurance is around $5,000 for a 28-day supply, so having insurance coverage can significantly impact the affordability of this medication. If your insurance changes, it is important to review your new plan's coverage and any restrictions or requirements they may have for specialty drugs like Forteo. Additionally, you may want to explore other options to help with the cost of Forteo, such as patient assistance programs or generic alternatives.

Medicare Part A or B may cover Forteo costs in some settings

Forteo is a prescription medication used to treat osteoporosis by promoting the growth of healthy bone and slowing down the process of bone loss. It is typically administered as an injection. The active ingredient in Forteo is teriparatide, which is very similar to the parathyroid gland hormone. While Forteo is often covered by Medicare, the extent of coverage depends on several factors, including the specific plan and coverage stage.

Medicare Part D, also known as the Medicare prescription drug coverage, typically does not cover the full cost of injectable drugs like Forteo. However, some Medicare prescription drug coverage options, including Medicare Advantage plans, may provide coverage for a percentage of the price. In such cases, there may still be substantial out-of-pocket costs for the patient.

Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) may cover the costs of Forteo in specific situations. If you are an inpatient at a skilled nursing facility or hospital and your doctor determines your medical need for Forteo, Medicare Part A may help cover the costs. Additionally, if a prescription drug like Forteo is medically necessary and administered in a clinical setting on an outpatient basis, Part B may help cover the costs. It is important to work with your doctor to ensure that the proper documentation has been filed to validate the necessity of the treatment.

It is worth noting that Forteo is considered a specialty drug, which may result in higher costs and additional barriers to coverage. These can include higher copay costs, prior authorization requirements, quantity limits, and restrictions on where the drug can be purchased. As such, it is recommended to call the insurance company and review coverage details before filling a Forteo prescription.

Forteo is a specialty drug, so there may be barriers to coverage

Secondly, prior authorization and quantity limits are common restrictions on Forteo coverage. Prior authorization rules require the prescriber to contact the insurance plan before the patient can get the medication to show that the drug is medically necessary. Quantity limits restrict the amount of the drug that can be filled at one time.

Finally, the insurance company may require the drug to be purchased from specialty pharmacies, which could potentially add to the cost.

Forteo is not covered by all insurance plans

Forteo is a brand-name prescription drug that helps increase bone mass in people with osteoporosis. It is a specialty drug, and as such, there may be some barriers to coverage. Forteo is not covered by all insurance plans.

Many health insurance plans, Medicare plans, and even Medicaid plans cover a Forteo prescription. It is also covered under Tricare and the VA. However, some insurance plans do not cover Forteo. For example, some people with Medicare Part D may not have coverage for Forteo, but Medicare Part B does cover it if a home healthcare provider injects it.

Medicare Part D is the part of Medicare that covers prescription drugs. A survey of plans conducted by GoodRx revealed that 93% of Medicare Part D plans covered the medication as of October 2021. However, this does not mean that all plans cover it. Additionally, Medicare Part D typically does not cover the full cost of an injectable drug, and there may still be a substantial out-of-pocket cost for the patient.

If your insurance plan does not cover Forteo, there are still some options to help with the cost. Eli Lilly offers a copay card that can reduce the cost if the eligibility criteria are met. Additionally, patient assistance programs may be available to help with the cost of the medication.

Forteo is a high-priced drug, but uninsured patients can save money

Forteo is a prescription drug used to treat osteoporosis by increasing bone mass and making bones stronger and less likely to break. It is a specialty drug, which means it is often expensive and may need to be filled through specialty pharmacies. The average price for a 28-day supply of Forteo is around $5,100 to $5,300 without insurance, which can be challenging for uninsured patients to afford. However, there are several ways that uninsured patients can save money on Forteo:

• Switch to the generic version: The generic version of Forteo, called teriparatide, is available at a lower cost. The average price for a 28-day supply of generic teriparatide is $3,200, which is almost $2,000 less than Forteo.
• Use a prescription discount card: Prescription discount cards, such as SingleCare or GoodRx, can help uninsured patients save money on Forteo. For example, with a SingleCare prescription discount card, patients can purchase Forteo for as little as $3,516 for 28 doses, saving up to $1,600.
• Consider Medicaid: Medicaid may be an option for uninsured patients to get affordable or even free Forteo. However, not all Medicaid plans cover Forteo, so it is important to check with an agent before committing to a plan.
• Apply for patient assistance programs: Patient assistance programs (PAPs) are typically sponsored by pharmaceutical companies and offer cost-free or discounted medicines to individuals with low incomes or those who are uninsured/underinsured. For example, the Lilly Cares Foundation Patient Assistance Program may be able to provide financial assistance for eligible patients who need help with Forteo.
• Look for alternative treatments: There are other specialty drugs that are FDA-approved for osteoporosis and may be less expensive than Forteo. These include parathyroid hormone injections such as Tymlos, and monoclonal antibodies such as Prolia (denosumab) and Evenity (romosozumab). The least expensive alternatives are bisphosphonates such as zoledronic acid and alendronate, which are usually tried before high-priced specialty drugs like Forteo.

Forteo is a prescription medication for osteoporosis

Forteo is used to treat osteoporosis caused by menopause, steroid use, or gonadal failure. It is for use when you have a high risk of bone fracture due to osteoporosis. It is only for men with osteoporosis and postmenopausal women. It is not used to prevent osteoporosis or to treat mild cases.

Forteo is a specialty drug, so there may be some barriers to insurance coverage. It is typically classified as a Tier 3 or Tier 4 drug by Medicare plans. It is not covered by all Medicare plans, and for those that do, there may be a substantial out-of-pocket cost for the patient.

Forteo is expensive, with a single pen injector with 2.4ml of the drug costing $5,110 without insurance. This is enough for 28 days of injections. Generic versions are available at a lower cost.

Frequently asked questions