Teriparatide subcutaneous injection – Alvogen — Medical Mutual

Initial criteria

• Natpara not available AND
• Not well-controlled on calcium supplements and active forms of vitamin D alone AND
• 25-hydroxyvitamin D stores sufficient before initiating therapy AND
• Serum calcium > 7.5 mg/dL before initiating therapy AND
• Creatinine clearance > 30 mL/min on two separate measurements OR CrCl > 60 mL/min and serum creatinine < 1.5 mg/dL AND
• Age ≥ 18 years AND
• History of hypoparathyroidism for > 18 months AND
• Prescribed by or in consultation with endocrinologist AND
• No history of Paget’s disease or unexplained alkaline phosphatase elevations AND
• No open epiphyses AND
• No hereditary disorders predisposing to osteosarcoma AND
• No prior external beam or implant radiation involving skeleton

Approval duration

1 year (initial and reauth); total max 2 years lifetime