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Teriparatide — Blue Cross Blue Shield of Alabama

Osteoporosis

Initial criteria

  • Prescriber states the patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days AND is at risk if therapy is changed OR the patient has a diagnosis of osteoporosis AND ALL of the following:
  • ONE of the following for sex and age:
  • - Male patient and age ≥ 50 years OR requested agent is medically appropriate for the patient’s age and sex
  • - Female patient and is postmenopausal OR requested agent is medically appropriate for the patient’s sex and menopausal status
  • Diagnosis confirmed by ONE of the following:
  • - Fragility fracture in the hip or spine
  • - T‑score of −2.5 or lower
  • - T‑score between −1.0 and −2.5 AND ONE of the following:
  • • Fragility fracture of proximal humerus, pelvis, or distal forearm
  • • FRAX 10‑year probability for major osteoporotic fracture ≥ 20%
  • • FRAX 10‑year probability of hip fracture ≥ 3%
  • AND ONE of the following:
  • - Patient is at very high fracture risk as defined by ONE of the following:
  • • Recent fracture (within past 12 months)
  • • Fractures while on FDA‑labeled osteoporosis therapy
  • • Multiple fractures
  • • Fractures while on drugs causing skeletal harm (e.g., long‑term glucocorticoids)
  • • Very low T‑score (< −3.0)
  • • High risk for falls or history of injurious falls
  • • Very high fracture probability by FRAX (major osteoporotic fracture > 30% or hip fracture > 4.5%) or by another validated risk algorithm
  • OR the patient has tried and had an inadequate response to a bisphosphonate (medical records required)
  • OR has an intolerance or hypersensitivity to a bisphosphonate (medical records required)
  • OR has an FDA‑labeled contraindication to ALL bisphosphonates (medical records required)
  • AND the patient will NOT use the requested agent in combination with a bisphosphonate, denosumab (e.g., Prolia, Xgeva), romosozumab‑aqqg, or another parathyroid hormone analog (e.g., teriparatide)
  • AND the patient does NOT have any FDA‑labeled contraindications to the requested agent
  • AND the total lifetime duration of treatment with FORTEO (teriparatide), Teriparatide, and TYMLOS (abaloparatide) has NOT exceeded 2 years

Approval duration

up to remainder of a total of 2 years lifetime treatment