Forteo — Cigna

Initial criteria

• Patient is either initiating or continuing systemic glucocorticoids; AND
• Patient meets ONE of the following (i, ii, iii, or iv):
• i. Patient has tried zoledronic acid intravenous infusion (Reclast); OR
• ii. Patient has tried at least one oral bisphosphonate or oral bisphosphonate-containing product and meets ONE of the following (a or b):
• a) According to the prescriber, patient has experienced inadequate efficacy to oral bisphosphonate therapy after a trial duration of 12 months; OR
• b) Patient has experienced significant intolerance to an oral bisphosphonate; OR
• iii. Patient cannot take an oral bisphosphonate due to ONE of the following (a, b, or c):
• a) Patient cannot swallow or has difficulty swallowing; OR
• b) Patient cannot remain in an upright position post oral bisphosphonate administration; OR
• c) Patient has a preexisting gastrointestinal medical condition; OR
• iv. Patient meets ONE of the following (a or b):
• a) According to the prescriber, the patient has severe renal impairment or chronic kidney disease; OR
• b) Patient has had an osteoporotic fracture or a fragility fracture; AND
• Patient meets ONE of the following (i or ii):
• i. According to the prescriber, if the patient is at high risk for fracture, approve for ONE of the following (a or b):
• a) If a patient is initiating therapy or has received a teriparatide product for < 1 year, approve for up to 2 years; OR
• b) If a patient has already received ≥ 1 year of therapy with a teriparatide product, approve for 1 year; OR
• ii. According to the prescriber, if the patient is not at high risk for fracture, approve for the duration necessary to complete a maximum of 2 years of therapy (total) during the patient’s lifetime.

Reauthorization criteria

• Use of a teriparatide product beyond 2 years is evaluated annually for continued high risk of fracture.

Approval duration

up to 2 years or 1 year depending on prior therapy duration