FORTEO — Blue Cross Blue Shield of Oklahoma

Preferred products

• FORTEO generic equivalent

Initial criteria

• 1. The patient has been diagnosed with osteoporosis OR has stage four advanced metastatic cancer or associated condition AND supporting chart notes are submitted.
• 2. The use of the requested agent is consistent with best practices and FDA approved use for the condition.
• 3. The patient has tried and had an inadequate response to a bisphosphonate OR has intolerance or hypersensitivity to a bisphosphonate OR has an FDA labeled contraindication to ALL bisphosphonates.
• 4. The patient will NOT be using the requested agent in combination with a bisphosphonate, denosumab (Prolia, Xgeva), romosozumab-aqqg, or another parathyroid hormone analog for osteoporosis (e.g., abaloparatide).
• 5. The patient does NOT have any FDA labeled contraindications to the requested agent.
• 6. ONE of the following applies: A. The total duration of treatment with parathyroid hormone analog(s) for osteoporosis has NOT exceeded 2 years in a lifetime OR B. The total duration has exceeded 2 years AND the patient is at high risk of fracture (evidenced by T-score, FRAX, or glucocorticoid use ≥5 mg prednisone daily).
• 7. FOR Ohio members with Fully Insured or HIM Shop plans: No FDA labeled contraindications AND EITHER: another FDA labeled indication for the agent and route, or compendia-supported indication, or two peer-reviewed journal articles supporting the use.

Reauthorization criteria

• 1. The patient continues to meet the initial criteria including diagnosis and contraindication considerations.
• 2. The total cumulative duration of therapy with parathyroid hormone analog(s) does not exceed 2 years, unless the patient remains at high fracture risk.

Approval duration

12 months (up to total of 2 years lifetime; up to 1 year if exceeded 2 years and at high fracture risk)