Tymlos (abaloparatide) — United Healthcare

Initial criteria

• One of the following: (1) Both of the following: Patient is female AND Diagnosis of postmenopausal osteoporosis OR (2) Both of the following: Patient is male AND Diagnosis of osteoporosis
• AND One of the following: (1) Patient is at high risk of fracture [e.g., recent fracture within the past 12 months, fractures while on approved osteoporosis therapy, multiple fractures, fractures while on drugs causing skeletal harm (e.g., long-term glucocorticoids), very low T-score (less than -3.0), high risk for falls or history of injurious falls, or very high fracture probability by FRAX (major osteoporosis fracture >30%, hip fracture >4.5%)] OR (2) Patient has a history of failure, intolerance or contraindication to other available osteoporosis therapy (e.g., alendronate, denosumab, risedronate, zoledronate)
• AND Treatment duration has not exceeded a total of 24 months of cumulative use of parathyroid hormone analogs (e.g., Teriparatide Injection, Forteo, Tymlos) during the patient’s lifetime

Approval duration

up to 24 months (limited to 24 months cumulative parathyroid hormone analog therapy lifetime)