Does Aetna Cover Forteo

Explore Aetna's Forteo coverage, reasons for denial, strategies to get approved, costs without insurance, and FAQs in this comprehensive guide.
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“Curex is changing the landscape of allergies in 2024”
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Forteo Coverage by Aetna

 

  • Aetna covers Forteo (teriparatide) for specific conditions and patient situations. Coverage typically includes osteoporosis treatment closely aligned with clinical guidelines.
  •  

  • Patients might be eligible for coverage if they have severe osteoporosis confirmed by bone mineral density tests or have experienced multiple bone fractures.
  •  

  • Prior authorization is usually required, meaning Aetna evaluates whether Forteo is medically necessary based on submitted documentation from healthcare providers.
  •  

  • Patients generally must have tried other osteoporosis treatments without success before Aetna approves Forteo, reflecting step therapy protocols.
  •  

  • Coverage criteria and guidelines can vary, so it's crucial for patients or providers to consult directly with Aetna or refer to individualized plan details for specific coverage information.

 

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Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Forteo Coverage with Aetna

 

Verify Your Policy Details

 

  • Log into your Aetna member portal to review your specific health insurance plan details. Look for information regarding prescription medication coverage.
  •  

  • Check for any specific details related to osteoporosis medications if mentioned. Forteo (teriparatide) is often categorized under specialty medications.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Forteo. Ensure that they understand that you plan to seek insurance coverage for it.
  •  

  • Ask your healthcare provider to provide a detailed medical necessity letter if Forteo is the recommended treatment for your condition.

 

Visit the Aetna Formulary Page

 

  • Go to the Aetna formulary page or use their drug search tool to confirm that Forteo is included in your plan's formulary list.
  •  

  • Check if there are any specific criteria or prior authorization requirements noted for Forteo.

 

Getting Pre-Authorization

 

  • Contact Aetna's customer service or pharmacy benefits department to learn about the pre-authorization process for Forteo.
  •  

  • Follow their guidelines to submit a pre-authorization request. This may involve sending your healthcare provider’s letter of medical necessity and any supporting documents.

 

File an Exception Request if Necessary

 

  • If Forteo is not covered under your plan, inquire about filing a formulary exception request. Ask Aetna for the required forms and procedures.
  •  

  • Ensure you have additional documentation supporting the necessity of Forteo, which may include clinical data or letters from other healthcare professionals.

 

Follow-Up and Documentation

 

  • Maintain a record of all communications with Aetna, including dates, times, and names of representatives spoken to regarding your coverage request.
  •  

  • Follow up consistently if no response is received from Aetna within the expected time frame.

 

Appeal a Denial

 

  • If coverage is denied, review Aetna’s appeal process in detail. Gather any additional evidence or documentation needed to support your appeal.
  •  

  • Submit your appeal within the timeframe specified by Aetna’s policy, and follow up to ensure it is being processed.

 

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Does Aetna Cover Forteo

Explore Aetna's Forteo coverage, reasons for denial, strategies to get approved, costs without insurance, and FAQs in this comprehensive guide.
Curex allergy drops unboxing

Is Forteo Covered by Aetna

 

Forteo Coverage by Aetna

 

  • Aetna covers Forteo (teriparatide) for specific conditions and patient situations. Coverage typically includes osteoporosis treatment closely aligned with clinical guidelines.
  •  

  • Patients might be eligible for coverage if they have severe osteoporosis confirmed by bone mineral density tests or have experienced multiple bone fractures.
  •  

  • Prior authorization is usually required, meaning Aetna evaluates whether Forteo is medically necessary based on submitted documentation from healthcare providers.
  •  

  • Patients generally must have tried other osteoporosis treatments without success before Aetna approves Forteo, reflecting step therapy protocols.
  •  

  • Coverage criteria and guidelines can vary, so it's crucial for patients or providers to consult directly with Aetna or refer to individualized plan details for specific coverage information.

 

A weight management program tailored to you

Start with Curex

Aetna's Approved Criteria for Forteo Coverage

 

Criteria for Forteo Coverage by Aetna

 

  • **Severe Osteoporosis Diagnosis**: Coverage is provided for members diagnosed with severe osteoporosis, defined as a T-score of -3.0 or lower, or for individuals who have experienced multiple vertebral fractures or other fracture history after minimal trauma.
  •  

  • **Inadequate Response to Other Therapies**: Approved if the member has had an inadequate response to, or intolerance of, other osteoporosis therapies such as bisphosphonates.
  •  

  • **High Risk of Fracture**: Indicated for patients who are at a high risk of fracture, including those with primary or secondary osteoporosis characterized by a history of osteoporotic fracture.
  •  

  • **Postmenopausal Women and Men with Hypogonadal Osteoporosis**: For postmenopausal women and men who are suffering from osteoporosis due to hypogonadism and have an increased risk of fractures.
  •  

  • **Glucocorticoid-Induced Osteoporosis**: Members who are on long-term glucocorticoid therapy and have a high risk of fractures may qualify for coverage.
  •  

  • **Paget’s Disease**: Individuals diagnosed with Paget's disease who are not responding well to other treatment options may be covered under this criterion.

 

Duration of Coverage

 

  • **24-Month Treatment Limitation**: Coverage for Forteo is limited to a 24-month lifetime course, subject to patient’s medical necessity and documented improvement in bone mineral density or decreased fracture incidence.

 

Why Aetna Might Deny Forteo Coverage

 

Reasons Aetna Might Deny Forteo Coverage

 

  • Forteo is not covered if it does not meet Aetna's criteria for medical necessity, as determined by their clinical policy guidelines.
  •  

  • Coverage is denied if the prescribed use of Forteo is outside the FDA-approved indications listed in Aetna's policy.
  •  

  • Aetna may deny coverage if there is insufficient documentation of medical need based on the patient's clinical condition or history of osteoporosis.
  •  

  • If a patient has reached the maximum recommended duration of therapy for Forteo, Aetna might not cover additional prescriptions.
  •  

  • Therapy may not be covered for individuals who have not been adequately screened for contraindications according to Aetna's criteria.
  •  

  • Aetna often denies coverage if there are cheaper alternative treatments available, unless the patient has documented contraindications or intolerance to those alternatives.
  •  

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Forteo Cost without Insurance?

 

Cost of Forteo Without Insurance

 

  • The price of Forteo (teriparatide injection) without insurance is quite substantial, typically ranging between $3,500 and $4,000 for a 28-day supply, which is a 2.4 mL pen of 600 mcg per 2.4 mL strength.
  •  

  • Keep in mind that pharmaceutical prices can vary based on the pharmacy, geographical location, and any available discounts or pharmacy-specific savings programs.
  •  

  • Patients can check with specific pharmacies for the most accurate pricing and inquire about any potential savings programs or discounts.
  •  

  • Consider contacting the manufacturer or exploring patient assistance programs, as they sometimes offer help to reduce costs for those without insurance coverage.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Forteo Coverage with Aetna

 

Verify Your Policy Details

 

  • Log into your Aetna member portal to review your specific health insurance plan details. Look for information regarding prescription medication coverage.
  •  

  • Check for any specific details related to osteoporosis medications if mentioned. Forteo (teriparatide) is often categorized under specialty medications.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Forteo. Ensure that they understand that you plan to seek insurance coverage for it.
  •  

  • Ask your healthcare provider to provide a detailed medical necessity letter if Forteo is the recommended treatment for your condition.

 

Visit the Aetna Formulary Page

 

  • Go to the Aetna formulary page or use their drug search tool to confirm that Forteo is included in your plan's formulary list.
  •  

  • Check if there are any specific criteria or prior authorization requirements noted for Forteo.

 

Getting Pre-Authorization

 

  • Contact Aetna's customer service or pharmacy benefits department to learn about the pre-authorization process for Forteo.
  •  

  • Follow their guidelines to submit a pre-authorization request. This may involve sending your healthcare provider’s letter of medical necessity and any supporting documents.

 

File an Exception Request if Necessary

 

  • If Forteo is not covered under your plan, inquire about filing a formulary exception request. Ask Aetna for the required forms and procedures.
  •  

  • Ensure you have additional documentation supporting the necessity of Forteo, which may include clinical data or letters from other healthcare professionals.

 

Follow-Up and Documentation

 

  • Maintain a record of all communications with Aetna, including dates, times, and names of representatives spoken to regarding your coverage request.
  •  

  • Follow up consistently if no response is received from Aetna within the expected time frame.

 

Appeal a Denial

 

  • If coverage is denied, review Aetna’s appeal process in detail. Gather any additional evidence or documentation needed to support your appeal.
  •  

  • Submit your appeal within the timeframe specified by Aetna’s policy, and follow up to ensure it is being processed.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Forteo FAQ

What are the common side effects of Forteo?

 

Common Side Effects of Forteo

 

  • Nausea: A frequent complaint among users, often resolves as your body adjusts to the medication.
  •  

  • Dizziness: Usually occurs after an injection, so sitting or lying down shortly afterward can help.
  •  

  • Leg Cramps: Regular stretching exercises may alleviate this discomfort.
  •  

  • Joint Pain: May be managed by over-the-counter painkillers, but consult your doctor first.
  •  

  • Injection Site Reactions: Mild redness or itching at the injection site is common, often soothed by cold compresses.

 

How does Forteo work for osteoporosis?

 

How Forteo Works

 

  • Forteo, or teriparatide, is a form of parathyroid hormone that helps stimulate new bone formation.
  •  

  • It works by increasing bone remodeling, which is crucial for improving bone density.

 

Osteoporosis Effectiveness

 

  • Used primarily for osteoporosis patients who have a high risk of fractures.
  •  

  • Improves bone microarchitecture, which enhances bone strength.

 

Administration

 

  • Administered via daily subcutaneous injection for up to 2 years.
  •  

  • Patients should follow their doctor’s instructions for the correct administration.

 

How long can you safely take Forteo?

 

Duration of Forteo Use

 

  • Forteo (teriparatide) is recommended for a maximum duration of 2 years over a patient's lifetime.
  •  

  • This limitation is based on studies that show an increased risk of osteosarcoma in rats. Though this risk hasn't been confirmed in humans, the duration is restricted for safety.

 

Considerations and Monitoring

 

  • During treatment, regular bone density scans and evaluations for potential side effects are necessary.
  •  

  • Patients should ensure they are not taking medications or have conditions that could further exacerbate potential risks.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide. Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Does Aetna Cover Forteo

Explore Aetna's Forteo coverage, reasons for denial, strategies to get approved, costs without insurance, and FAQs in this comprehensive guide.
Curex allergy drops unboxing

Does Aetna Cover Forteo

 

Forteo Coverage by Aetna

 

  • Aetna covers Forteo (teriparatide) for specific conditions and patient situations. Coverage typically includes osteoporosis treatment closely aligned with clinical guidelines.
  •  

  • Patients might be eligible for coverage if they have severe osteoporosis confirmed by bone mineral density tests or have experienced multiple bone fractures.
  •  

  • Prior authorization is usually required, meaning Aetna evaluates whether Forteo is medically necessary based on submitted documentation from healthcare providers.
  •  

  • Patients generally must have tried other osteoporosis treatments without success before Aetna approves Forteo, reflecting step therapy protocols.
  •  

  • Coverage criteria and guidelines can vary, so it's crucial for patients or providers to consult directly with Aetna or refer to individualized plan details for specific coverage information.

 

A weight management program tailored to you

Start with Curex

Why Aetna Might Deny Forteo Coverage

 

Criteria for Forteo Coverage by Aetna

 

  • **Severe Osteoporosis Diagnosis**: Coverage is provided for members diagnosed with severe osteoporosis, defined as a T-score of -3.0 or lower, or for individuals who have experienced multiple vertebral fractures or other fracture history after minimal trauma.
  •  

  • **Inadequate Response to Other Therapies**: Approved if the member has had an inadequate response to, or intolerance of, other osteoporosis therapies such as bisphosphonates.
  •  

  • **High Risk of Fracture**: Indicated for patients who are at a high risk of fracture, including those with primary or secondary osteoporosis characterized by a history of osteoporotic fracture.
  •  

  • **Postmenopausal Women and Men with Hypogonadal Osteoporosis**: For postmenopausal women and men who are suffering from osteoporosis due to hypogonadism and have an increased risk of fractures.
  •  

  • **Glucocorticoid-Induced Osteoporosis**: Members who are on long-term glucocorticoid therapy and have a high risk of fractures may qualify for coverage.
  •  

  • **Paget’s Disease**: Individuals diagnosed with Paget's disease who are not responding well to other treatment options may be covered under this criterion.

 

Duration of Coverage

 

  • **24-Month Treatment Limitation**: Coverage for Forteo is limited to a 24-month lifetime course, subject to patient’s medical necessity and documented improvement in bone mineral density or decreased fracture incidence.

 

Together with our partners we have changed the lives of over 300,000 patients.

Forteo FAQ

 

Reasons Aetna Might Deny Forteo Coverage

 

  • Forteo is not covered if it does not meet Aetna's criteria for medical necessity, as determined by their clinical policy guidelines.
  •  

  • Coverage is denied if the prescribed use of Forteo is outside the FDA-approved indications listed in Aetna's policy.
  •  

  • Aetna may deny coverage if there is insufficient documentation of medical need based on the patient's clinical condition or history of osteoporosis.
  •  

  • If a patient has reached the maximum recommended duration of therapy for Forteo, Aetna might not cover additional prescriptions.
  •  

  • Therapy may not be covered for individuals who have not been adequately screened for contraindications according to Aetna's criteria.
  •  

  • Aetna often denies coverage if there are cheaper alternative treatments available, unless the patient has documented contraindications or intolerance to those alternatives.
  •  

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How Much Does Forteo Cost without Insurance?

 

Cost of Forteo Without Insurance

 

  • The price of Forteo (teriparatide injection) without insurance is quite substantial, typically ranging between $3,500 and $4,000 for a 28-day supply, which is a 2.4 mL pen of 600 mcg per 2.4 mL strength.
  •  

  • Keep in mind that pharmaceutical prices can vary based on the pharmacy, geographical location, and any available discounts or pharmacy-specific savings programs.
  •  

  • Patients can check with specific pharmacies for the most accurate pricing and inquire about any potential savings programs or discounts.
  •  

  • Consider contacting the manufacturer or exploring patient assistance programs, as they sometimes offer help to reduce costs for those without insurance coverage.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.