Osteoporosis affects approximately 20 million people in the United States. This degenerative bone condition is most commonly diagnosed in women who have gone through menopause and men over the age of 65. Left untreated, osteoporosis can lead to bone fractures. Treatment including physical therapy and strengthening exercises can help, but once osteoporosis has set in, treatment with therapeutic drugs like Forteo may be necessary.
What is Forteo?
Forteo (teriparatide) is a medication that is typically administered as an injection It uses proteins to replace bone that has been lost due to degeneration, while improving the health of existing bone. This drug is usually prescribed to individuals who are at a greater risk of suffering from bone injuries, but it may also be a treatment for those who have already suffered a broken or fractured bone due to osteoporosis. Patients prescribed Forteo may be required to undergo routine testing that includes x-rays and bone biopsy procedures to monitor the density of bone and to ensure that bone is healing and being replaced properly after a fracture or break.
Does Medicare Cover Forteo?
As with many injectable medications, Medicare’s coverage of Forteo depends on a number of factors. In general, Medicare does not cover the full cost of an injectable drug under Part D, also known as the Medicare prescription drug coverage. Part D generally provides benefits for drugs that are available through a traditional retail pharmacy. Some Medicare prescription drug coverage options, including Medicare Advantage plans, may provide coverage for a percentage of the price, but there may still be a substantial out-of-pocket cost for the patient. You can check your plan’s formulary to see a full list of covered medications, and it is recommended that you discuss your needs with your plan directly for details regarding any supplemental benefits that may offset the cost of non-covered medications.
Medicare May Cover Costs in Some Settings
While Medicare Part D will not provide full coverage for Forteo, you may be able to receive coverage under Medicare Part A or Part B. These two parts of Medicare allow for additional coverage of medication administered in specific situations. If you are an inpatient at a skilled nursing facility or hospital when your doctor determines your medical need for Forteo, Medicare Part A may help cover the costs.
When a prescription drug is medically necessary and is administered in a clinical setting on an outpatient basis, Part B may help cover the costs. Work with your doctor to ensure that the proper documentation has been filed to validate the necessity of treatment. You may not need to receive prior approval if Forteo needs to be administered as part of a medical procedure undertaken to stabilize health in an emergency situation where treatment is given at a hospital.
Assistance Programs May Be Available
For Medicare recipients who are unable to receive coverage for Forteo, assistance programs may be available to help. There are a number of options provided through cost-sharing programs that allow people to receive financial assistance in either covering the cost of medications completely or by providing large discounts on drugs through agreements with manufacturers and distributors.