Forteo (teriparatide) is a brand-name drug that doctors prescribe for some people with osteoporosis. It contains proteins that strengthen bones and stimulate new bone growth. A typical prescription is one subcutaneous Forteo injection daily.
The amount a person with Medicare will pay for Forteo injections depends on several factors, such as:
- their insurance plan
- their treatment plan
- how much of the drug they need
- the pharmacy they use
An individual will also need to pay for pen needles to inject Forteo, as they are not included with the drug.
Medicare prescription drug plans (Part D) are the main way to get coverage for Forteo. Some Medicare Advantage plans also cover this medication.
People with a Part D supplement plan or a Medicare Advantage plan can check their plan’s formulary to see if it includes Forteo. A formulary is a list of drugs the insurance plan covers. Alternatively, they can ask their doctor, pharmacist, or insurance provider to check whether their plan covers Forteo.
Prior authorization may be necessary before an insurer agrees to cover Forteo. This involves a discussion between a person’s doctor and insurer about their need for the drug. A person needs to get prior authorization, if necessary, before starting treatment, or they may need to pay the full cost of the drug.
Medicare resources
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Original Medicare (parts A and B) may pay toward the cost of Forteo and home health visits to inject the drug if someone meets all these criteria:
- they are female
- they meet the criteria for home health services, which include being “homebound”
- they have a bone fracture relating to postmenopausal osteoporosis, which a healthcare professional has certified
- they or their caregivers cannot administer the injection, and a healthcare professional certifies this
If a person with Original Medicare meets those criteria, they must first meet the Part B deductible of $185 and then up to 20% of the Medicare-approved amount for Forteo. This amount can change if the drug’s price fluctuates. There is no charge for the home health nurse’s visit to inject the drug.
Teriparatide is the generic version of Forteo and may be a cheaper alternative that is just as safe and effective as the branded version. However, Medicare drug plans may not cover it. A person can talk with their doctor about the most cost-effective way to receive the osteoporosis injection they need.
Read more about osteoporosis medications.
