Forteo (teriparatide) — Highmark

osteoporosis in men with primary or hypogonadal osteoporosis at high risk for fracture

Preferred products

The member is at high risk for a fracture as defined by one of the following: (a) history of a previous hip fracture (ICD-10: M84.35) or vertebral fracture (ICD-10: S22.0); OR (b) diagnosis of osteoporosis (ICD-10: M80-M81) defined as a T-score ≤ -2.5; OR (c) diagnosis of osteopenia with T-score between -1.0 and -2.5 AND one of: (i) 10-year risk of major osteoporotic fracture ≥ 20% using FRAX; OR (ii) 10-year risk of hip fracture ≥ 3% using FRAX; OR (iii) member age ≥ 40 years AND history of glucocorticoid use at ≥5 mg/day prednisone (or equivalent) for ≥3 months.
The member has experienced therapeutic failure or intolerance to one bisphosphonate, or all bisphosphonates are contraindicated.
If the request is for brand Forteo, the member has experienced therapeutic failure or intolerance to generic teriparatide.
If the member is a male or postmenopausal female at high risk for fracture, one of the following: (a) therapeutic failure, contraindication, or intolerance to plan-preferred Tymlos; OR (b) request is for treatment of osteoporosis associated with sustained systemic glucocorticoid therapy.
The total cumulative duration of Forteo therapy does not exceed 24 months, OR the prescriber attests the member remains at or has returned to having a high risk for fracture.
The member is not receiving Forteo in combination with other parathyroid hormone analogs, RANKL inhibitors, or sclerostin inhibitors.

Prescriber attests that the member remains at or has returned to having a high risk for fracture.
Total cumulative duration of Forteo therapy does not exceed 24 months.

up to 24 months