Osteoporosis is a serious condition that weakens bones and affects millions of people in the U.S. It’s most common in postmenopausal women and men over the age of 65.
While exercise and therapy can help, sometimes medications like Forteo (Teriparatide) are needed to prevent fractures and strengthen bones. But here’s the big question: Does Medicare cover it, and what will it cost you? Let’s break down Medicare coverage for Forteo!
What Exactly is Forteo?
Forteo (teriparatide) is an osteoporosis medication designed to help rebuild and strengthen bones. Unlike some treatments that just slow bone loss, Forteo uses proteins to actively replace lost bone and boost the health of existing bone.
It’s typically prescribed for those at high risk of fractures or for patients who’ve already experienced a break due to osteoporosis.
To track progress, patients on Forteo often undergo regular testing, like x-rays and bone density scans, to ensure the treatment is effectively rebuilding and healing their bones.
Does Medicare Cover Forteo?
Medicare coverage for Forteo depends on several factors and isn’t always straightforward. Typically, Medicare Part D, which handles prescription drug coverage, doesn’t fully cover the cost of injectable medications like Forteo.
However, some Medicare Advantage plans or supplemental policies might offer partial assistance, but it varies widely. Because the Forteo cost can add up quickly, it’s essential to review your Medicare plan carefully and explore all available options for financial support.
Speaking with your provider or pharmacist can help clarify what’s covered and how to manage any out-of-pocket expenses.
Which Parts of Medicare Cover Forteo?
Medicare Part D | Yay Images
Forteo is primarily covered under Medicare Part D. If you have a Medicare Advantage plan, you may also find coverage, but it depends on your specific plan. To confirm, check your plan’s formulary – this is the list of medications your insurance covers.
Need help? Your doctor, pharmacist, or insurance provider can assist in finding out if Forteo is included. However, keep in mind that prior authorization may be required.
This step ensures your doctor and insurer agree on the need for Forteo before you begin treatment, helping you avoid paying the full cost out-of-pocket.
Can You Get Forteo with Original Medicare?
While original Medicare (Parts A and B) might cover Forteo and related home health services, it does come with specific requirements. To qualify, you must be female, certified as homebound by a healthcare provider, and have a bone fracture caused by postmenopausal osteoporosis.
Additionally, a doctor must confirm that neither you nor your caregiver can safely administer the injection at home.
If you meet these criteria, Medicare Part B will cover Forteo after you pay the annual deductible, which is $185. After that, you’ll be responsible for up to 20% of the Medicare-approved Forteo cost, which can fluctuate based on the drug’s pricing.
The good news? Home health nurse visits to administer the injection are fully covered, meaning no extra charge for that service.
Assistance Programs May Be Available
If Medicare coverage for Forteo doesn’t fully meet your needs, assistance programs could help bridge the gap.
Many cost-sharing programs offer financial aid, either by covering the medication’s cost entirely or providing significant discounts through partnerships with manufacturers and distributors.
These programs are designed to make medications like Forteo more affordable for those who might struggle to pay out-of-pocket. If you’re eligible, they can greatly reduce your financial burden and ensure you get the treatment you need.
Check with your doctor or pharmacist for guidance on available options.
How Much Does Forteo Cost with Insurance vs. Without It?
The cost of Forteo can vary significantly depending on whether or not you have insurance. Without insurance, factors like the supply amount (30-day or 90-day), the pharmacy you choose, and eligibility for savings programs can all influence the price.
If you have insurance, these same factors apply, but your specific plan benefits and any prior authorization requirements will also play a big role in determining what you pay.
So, it’s important to check with your provider and pharmacist to understand the full cost, whether you’re insured or not.
Is There a Way to Reduce Costs if You Take Forteo Long Term?
If you’re prescribed Forteo for the long term, there are ways to help reduce the overall cost.
Getting More Than a One-month Supply
Many insurance plans, including Medicare, may allow you to get a 90-day supply of Forteo instead of the usual 30 days.
This can lower the cost per dose and reduce how often you need to visit the pharmacy. Check with your doctor, pharmacist, or insurance provider to see if this option is available.
Using a Mail-order Pharmacy
A delivery waiting to hand over an order | Pexels
Mail-order pharmacies often provide medications like Forteo at a lower cost. This option is convenient, delivering the medication straight to your home.
Some Medicare plans may also help cover mail-order prescriptions, and you might even qualify for a 90-day supply through this service.
If you’re uninsured, speak with your doctor or pharmacist. They may recommend online pharmacies or other cost-saving options to make long-term Forteo use more affordable.
Final Notes
Forteo (teriparatide) is an important osteoporosis medication designed to rebuild and strengthen bones, particularly for individuals at high risk of fractures. It’s a powerful treatment option for managing osteoporosis when other measures, like exercise or diet, aren’t enough.
When it comes to Medicare coverage for Forteo, the specifics can vary widely. Medicare Part D or Medicare Advantage plans may provide partial coverage, but understanding your plan’s benefits, formularies, and requirements is crucial.
For those who qualify, assistance programs or cost-saving options like mail-order pharmacies can help. Just consult your doctor, pharmacist, or insurance provider to ensure you get the care and coverage you need.