Teriparatide — Point32Health

Initial criteria

• Documentation of one (1) of the following: a. T-score ≤ -2.5 OR b. T-score between -1.0 and -2.5 AND prescriber determines patient is at high risk for fracture OR c. FRAX score of 10-year risk of major osteoporotic fracture ≥20% or risk of hip fracture ≥3% OR d. One or more osteoporotic fracture
• AND Documentation of one (1) of the following: a. Inadequate response to, or inability to tolerate at least one traditional osteoporosis treatment (e.g., alendronate, calcitonin, denosumab, ibandronate, raloxifene, risedronate, zoledronic acid) OR b. Contraindication to all traditional osteoporosis treatments (e.g., alendronate, calcitonin, denosumab, ibandronate, raloxifene, risedronate, zoledronic acid) OR c. Patient is at very high risk for fracture (e.g., T-score ≤ -3.0 in absence of fragility fracture(s), T-score ≤ -2.5 plus fragility fracture, or multiple fractures) OR d. Patient is new to the plan and stable on the requested agent prior to enrollment

Reauthorization criteria

• Documentation that the patient remains at or has returned to having a high risk for fracture despite a total of 24 months of use of the requested Parathyroid Hormone product

Approval duration

initial 24 months; reauth 12 months