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Is Forteo covered by insurance? | How much does Forteo cost without insurance? | How to get Forteo without insurance
Forteo is a brand-name prescription drug that helps increase bone mass in people with osteoporosis. For Forteo to be used, bone loss has to be severe enough that there is a high risk of fractures. The active ingredient in Forteo is teriparatide. It is very similar to parathyroid gland hormone, which stimulates bone growth. Though intended for postmenopausal women and men with low testosterone, Forteo is FDA-approved to treat anyone with osteoporosis due to bone disease. Forteo is a once-daily subcutaneous injection that comes as a reusable pen injector. Though both Forteo and its generic version are high-priced drugs, uninsured patients do have ways to save money.
What is the generic for Forteo?
The generic version of Forteo is teriparatide. The average price for a 28-day supply of generic teriparatide is $3,200 compared to $5,100 for Forteo.
Is Forteo covered by insurance?
Many health insurance plans, Medicare plans, and even Medicaid plans cover a Forteo prescription. It’s also covered under Tricare and the VA. Some insurance plans don’t cover Forteo.
Forteo is a specialty drug, so there may be a few barriers to coverage. The first is the copay cost. Most insurance plans classify Forteo as a specialty drug, the highest drug tier. Eli Lilly offers a copay card, which might help if the eligibility criteria are met. In addition, prior authorization and quantity limits are common restrictions. Finally, the insurance company may require the drug to be purchased from specialty pharmacies, potentially adding to the cost.
Some people with Medicare Part D may not have coverage for Forteo, but Medicare Part B does cover it if a home healthcare provider injects it.
Because of all these issues, call the insurance company and review coverage before filling a Forteo prescription.
How much does Forteo cost without insurance?
Without the help of health insurance, a single pen injector with 2.4 mL of 600 mcg of Forteo will cost $5,110. That’s enough medicine for 28 days of daily injections, about $182 per injection. Forteo can be prescribed for as long as two years, so a full year of treatment could cost over $65,000 for anyone paying the full retail price for monthly refills.
Switching to generic teriparatide injections can help reduce the cost to an average of $3,200 every 28 days. The injection delivery device is slightly different but simple enough to allow self-injections.
People without insurance can also ask the prescribing healthcare provider about parathyroid hormone injections such as Tymlos. They may cost less.
Other specialty drugs FDA-approved for osteoporosis include monoclonal antibodies such as Prolia (denosumab), which prevents bone loss, and Evenity (romosozumab), which builds bone density. Both cost less than Forteo and are given in fewer doses. For instance, only two doses of Prolia are required per year. The annual savings may be considerable.
The least expensive alternatives to Forteo are bisphosphonates such as zoledronic acid and alendronate. These drugs are the first-line treatment for osteoporosis, so they are usually used before high-priced specialty drugs like Forteo are prescribed.
RELATED: Forteo alternatives: What can I take instead of Forteo?
Compare Forteo prices to related drugs |
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|---|---|---|---|
| Drug name | Price without insurance of brand-name drug | SingleCare price | Savings options |
| Forteo | $5,110 per 1, 2.4 mL of 600 mcg/2.4 mL, pen-injector | $3516 per 1, 2.4 mL of 600 mcg/2.4 mL, pen-injector | See latest prices |
| Prolia | $1872 per 1 mL of 60 mg/mL, prefilled syringe | $1563 1 mL of 60 mg/mL, prefilled syringe of brand-name Prolia | See latest prices |
| Reclast | $1333 per for 1,100 mL of 5 mg/100 mL solution | $53 per 1,100 ml of 5 mg/100 mL solution of generic Reclast | See latest prices |
| Alendronate | $54 per 1, 70 mL/ 75 mg, 4 tablet box of generic alendronate | $2 per 1, 70 mL/ 75 mg, 4 tablet box of generic alendronate | See latest prices |
Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. The listed price without insurance references the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs, if available. Click the “Savings options” link to see the latest drug prices.
How to get Forteo without insurance
Specialty drugs like Forteo may not be easy to purchase without insurance. They may be challenging to afford even with insurance. Patient assistance programs may help, but not everyone will meet the eligibility requirements. Here are some other ways to save on a Forteo prescription.
1. Use a SingleCare savings card
With a SingleCare prescription discount card, Forteo can be purchased for as little as $3,516 for 28 doses, a $1,600 savings. Forteo discounts vary by participating pharmacy, so visit SingleCare’s Forteo coupon page for current discount prices.
2. Find the lowest price
The highest pharmacy price for Forteo is $3,000 higher than the average retail price. The lowest price is about $4,000 lower than the highest price. It pays to compare prices, so start by looking over SingleCare’s average 12-month price table on the Forteo coupon page.
3. Consider Medicaid
Medicaid may be an option for getting affordable or free Forteo for some people. Some Medicaid plans may not cover Forteo, so get help from an agent before committing to a plan. Visit your state’s Medicaid website for eligibility requirements, enrollment, and additional information.
4. Ask the prescriber about generic Forteo
A prescription for generic teriparatide injections costs almost $2,000 less than Forteo. A SingleCare discount card can reduce that cost by another $800, saving close to $3,000 monthly.
5. Ask for medical advice about other osteoporosis treatments
The least expensive drugs for osteoporosis are usually tried before specialty drugs like Forteo are prescribed. Still, some specialty osteoporosis drugs are less expensive than Forteo. These include parathyroid hormone injections and monoclonal antibodies. Discuss the trade-offs with a healthcare professional before committing to the switch.
