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Teriparatide — Blue Cross Blue Shield of Alabama

Glucocorticoid-induced osteoporosis

Preferred products

  • Tymlos (abaloparatide)

Initial criteria

  • ONE of the following:
  • • The requested agent is FORTEO generic equivalent AND ONE of the following: The patient has been treated with the requested agent (not samples) within the past 90 days OR prescriber states patient has been treated within past 90 days AND is at risk if therapy is changed
  • • The patient has a diagnosis of osteoporosis and ALL of the following:
  •   - ONE of the following: patient’s sex is male and (age ≥ 50 years OR agent medically appropriate for age/sex); OR patient’s sex is female and (postmenopausal OR agent medically appropriate for sex/menopause status)
  •   - Diagnosis confirmed by ONE of the following: fragility fracture in hip or spine OR T-score ≤ -2.5 OR T-score -1.0 to -2.5 plus (fragility fracture of proximal humerus/pelvis/distal forearm OR FRAX major fracture ≥ 20% OR FRAX hip fracture ≥ 3%)
  •   - ONE of the following: patient at very high fracture risk (recent fracture within 12 months; fractures while on therapy; multiple fractures; fractures on drugs causing skeletal harm; 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 required)
  •   - ONE of the following: requested agent is FORTEO generic equivalent OR brand FORTEO AND BOTH of the following: patient has intolerance/hypersensitivity/contraindication to generic not expected with brand AND tried/inadequate response/intolerance/contraindication to TYMLOS (abaloparatide)
  • • OR the patient has 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 and (prior fracture OR glucocorticoids ≥30 mg/day OR cumulative ≥5 g/year); OR if age ≥ 40 and (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 required)
  •   - ONE of the following: requested agent is FORTEO generic equivalent OR brand FORTEO AND intolerance/hypersensitivity/contraindication to generic not expected with brand
  • AND patient will NOT use in combination with bisphosphonate, denosumab, romosozumab-aqqg, or another parathyroid hormone analog (abaloparatide)
  • AND patient does NOT have any FDA labeled contraindications to the requested agent
  • AND ONE of the following: total therapy with parathyroid hormone analogs ≤ 2 years lifetime OR therapy >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