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Teriparatide (non-preferred) — Blue Cross Blue Shield of Alabama

Osteoporosis

Preferred products

  • Tymlos (abaloparatide)
  • Forteo generic equivalent

Initial criteria

  • ONE of the following:
  • • The patient has a diagnosis of osteoporosis and ALL of the following:
  •   - ONE of the following: male ≥50 years or appropriate per age/sex; female postmenopausal or appropriate for sex/menopause
  •   - Diagnosis confirmed by ONE of the following: fragility fracture hip/spine OR T-score ≤ -2.5 OR T-score -1.0 to -2.5 + (fragility fracture of proximal humerus/pelvis/distal forearm OR FRAX major ≥20% OR FRAX hip ≥3%)
  •   - ONE of the following: very high fracture risk (recent fracture <12 months, fractures on therapy, multiple fractures, fractures while on harmful drugs, very low T-score < -3.0, high fall risk, FRAX major >30% or hip >4.5%) OR inadequate response/intolerance/contraindication to bisphosphonate (medical records)
  •   - BOTH of the following: inadequate response/intolerance/contraindication to FORTEO generic AND to TYMLOS (abaloparatide)
  • • OR the patient has a diagnosis of glucocorticoid-induced osteoporosis and ALL of the following:
  •   - Taking or initiating glucocorticoids ≥5 mg prednisone equivalent daily, expected ≥3 months
  •   - ONE of the following: if age <40 (prior fracture OR glucocorticoids ≥30 mg/day OR cumulative ≥5 g/year); if ≥40 (prior osteoporotic fracture OR T-score ≤ -2.5 OR FRAX major ≥20% OR FRAX hip ≥3% OR glucocorticoids ≥30 mg/day >30 days OR cumulative ≥5 g/year)
  •   - OR inadequate response/intolerance/contraindication to bisphosphonate (medical records)
  •   - Inadequate response/intolerance/contraindication to FORTEO generic
  • AND patient will NOT use in combination with bisphosphonate, denosumab, romosozumab-aqqg, or another parathyroid hormone analog (abaloparatide)
  • AND patient has no FDA labeled contraindications to requested agent
  • AND ONE of the following: total duration of parathyroid hormone analog treatment ≤2 years lifetime OR >2 years lifetime AND patient at high fracture risk (T-score, FRAX, ongoing glucocorticoids ≥5 mg prednisone daily)

Approval duration

up to remainder of 2 years lifetime; if already ≥2 years and high fracture risk, 1 year