Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Forteo

Explore Forteo coverage by Florida Blue, reasons for denial, securing coverage, costs without insurance, and FAQs in our comprehensive guide.
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“Curex is changing the landscape of allergies in 2024”
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Eligibility for Forteo Coverage with Florida Blue

 

  • Florida Blue may cover Forteo (teriparatide) for patients meeting specific clinical criteria associated with certain forms of osteoporosis.
  •  

  • Coverage is typically considered for individuals who have a high risk of fractures, particularly postmenopausal women and men who have tried and failed other therapies.
  •  

    Criteria for Coverage

     

    • The patient must have experienced an osteoporotic fracture or have multiple risk factors for fracture.
    •  

    • Prior treatment with other osteoporosis medications that were ineffective or unsuitable is usually required.

     

    Important Notes

     

    • Pre-authorization from Florida Blue may be necessary to ensure Forteo is covered under the individual’s health plan.
    •  

    • Coverage details can vary, so it is important to verify specific plan benefits directly with Florida Blue.

     

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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 Florida Blue (Blue Cross Blue Shield of Florida)

 

Verify Coverage for Forteo

 

  • Contact Florida Blue customer service to confirm if Forteo is covered under your specific insurance plan. You can find contact information on your insurance card or the Florida Blue website.
  •  

  • Review your policy documents for any mention of prescription drug coverage and verify if Forteo is included.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Forteo for your condition, as insurers often require proof of necessity for coverage.
  •  

  • Request a letter of medical necessity from your healthcare provider, detailing why Forteo is required for your treatment.

 

Preauthorization Process

 

  • Check if Florida Blue requires precertification or preauthorization for Forteo. This is often needed for high-cost medications and requires documentation and justification from your doctor.
  •  

  • Your doctor's office will typically coordinate with Florida Blue to submit the necessary documentation for authorization. Make sure all paperwork is completed accurately to avoid delays.

 

Filling the Prescription

 

  • Once you receive confirmation that Forteo is covered and preauthorized, choose a pharmacy that is within the Florida Blue network to fill your prescription.
  •  

  • Discuss with the pharmacist about any copayments or additional costs you might incur. They can help understand the financial aspects of the medication.

 

Follow-Up and Appeal

 

  • If your initial request is denied, review the reasons for denial provided by Florida Blue. They usually give specific reasons and next steps for a coverage determination.
  •  

  • Work with your healthcare provider to appeal the decision if necessary. Include all relevant documents, such as the medical necessity letter, test results, and a detailed explanation of why Forteo is essential for your treatment.

 

Utilize Florida Blue Resources

 

  • Explore Florida Blue's member portal for additional resources, such as digital authorization forms or online customer service chat, to assist with the process.
  •  

  • Consider speaking with a Florida Blue case manager if the appeals process becomes complex. They can offer guidance and support throughout the process.

 

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Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Forteo

Explore Forteo coverage by Florida Blue, reasons for denial, securing coverage, costs without insurance, and FAQs in our comprehensive guide.
Curex allergy drops unboxing

Is Forteo Covered by Florida Blue (Blue Cross Blue Shield of Florida)

 

Eligibility for Forteo Coverage with Florida Blue

 

  • Florida Blue may cover Forteo (teriparatide) for patients meeting specific clinical criteria associated with certain forms of osteoporosis.
  •  

  • Coverage is typically considered for individuals who have a high risk of fractures, particularly postmenopausal women and men who have tried and failed other therapies.
  •  

    Criteria for Coverage

     

    • The patient must have experienced an osteoporotic fracture or have multiple risk factors for fracture.
    •  

    • Prior treatment with other osteoporosis medications that were ineffective or unsuitable is usually required.

     

    Important Notes

     

    • Pre-authorization from Florida Blue may be necessary to ensure Forteo is covered under the individual’s health plan.
    •  

    • Coverage details can vary, so it is important to verify specific plan benefits directly with Florida Blue.

     

A weight management program tailored to you

Start with Curex

Florida Blue (Blue Cross Blue Shield of Florida)'s Approved Criteria for Forteo Coverage

 

Approved Criteria for Forteo Coverage

 

  • Patient must be diagnosed with osteoporosis that meets the level of severity required for treatment with Forteo, indicating a high risk of fracture.
  •  

  • Patient should have a history of osteoporotic fracture(s) or multiple risk factors for fracture.
  •  

  • The patient must have had an insufficient response, or be intolerant, to previous osteoporosis therapy, such as bisphosphonates.
  •  

  • Patient should be postmenopausal women or men with primary or hypogonadal osteoporosis who meet the coverage criteria.
  •  

  • Patients undergoing treatment should be adults over the age of 18.
  •  

  • Medical documentation is required indicating the necessity of Forteo treatment, including pertinent medical history and response to prior therapies.
  •  

  • Request for coverage should be made by a healthcare provider with the proper credentialing, supporting the necessity of the Forteo therapy.
  •  

  • Ensure that the prescribed use aligns with FDA-approved indications for Forteo treatment.
  •  

 

Why Florida Blue (Blue Cross Blue Shield of Florida) Might Deny Forteo Coverage

 

Situations When Florida Blue Might Deny Forteo Coverage

 

  • Forteo is not prescribed for an FDA-approved indication. This could include uses not recognized or not considered medically necessary per guidelines.
  •  

  • The individual has not met the necessary prerequisite treatment course. This often includes failing to try or respond to preferred medications that are less costly or more widely accepted by the policy.
  •  

  • Lack of documentation or insufficient information provided by the physician regarding the patient's condition. This might include missing details on the severity of osteoporosis or previous treatment history.
  •  

  • The patient's osteoporosis condition does not meet the severity criteria set by the insurer. For example, not having experienced a fracture or having a T-score that does not align with the insurer’s requirements.
  •  

  • Prescriptions written by out-of-network healthcare providers who are not recognized by Florida Blue’s network, unless circumstances warrant such an external prescription.

 

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 Florida Blue (Blue Cross Blue Shield of Florida)

 

Verify Coverage for Forteo

 

  • Contact Florida Blue customer service to confirm if Forteo is covered under your specific insurance plan. You can find contact information on your insurance card or the Florida Blue website.
  •  

  • Review your policy documents for any mention of prescription drug coverage and verify if Forteo is included.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Forteo for your condition, as insurers often require proof of necessity for coverage.
  •  

  • Request a letter of medical necessity from your healthcare provider, detailing why Forteo is required for your treatment.

 

Preauthorization Process

 

  • Check if Florida Blue requires precertification or preauthorization for Forteo. This is often needed for high-cost medications and requires documentation and justification from your doctor.
  •  

  • Your doctor's office will typically coordinate with Florida Blue to submit the necessary documentation for authorization. Make sure all paperwork is completed accurately to avoid delays.

 

Filling the Prescription

 

  • Once you receive confirmation that Forteo is covered and preauthorized, choose a pharmacy that is within the Florida Blue network to fill your prescription.
  •  

  • Discuss with the pharmacist about any copayments or additional costs you might incur. They can help understand the financial aspects of the medication.

 

Follow-Up and Appeal

 

  • If your initial request is denied, review the reasons for denial provided by Florida Blue. They usually give specific reasons and next steps for a coverage determination.
  •  

  • Work with your healthcare provider to appeal the decision if necessary. Include all relevant documents, such as the medical necessity letter, test results, and a detailed explanation of why Forteo is essential for your treatment.

 

Utilize Florida Blue Resources

 

  • Explore Florida Blue's member portal for additional resources, such as digital authorization forms or online customer service chat, to assist with the process.
  •  

  • Consider speaking with a Florida Blue case manager if the appeals process becomes complex. They can offer guidance and support throughout the process.

 

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 Florida Blue (Blue Cross Blue Shield of Florida) Cover Forteo

Explore Forteo coverage by Florida Blue, reasons for denial, securing coverage, costs without insurance, and FAQs in our comprehensive guide.
Curex allergy drops unboxing

Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Forteo

 

Eligibility for Forteo Coverage with Florida Blue

 

  • Florida Blue may cover Forteo (teriparatide) for patients meeting specific clinical criteria associated with certain forms of osteoporosis.
  •  

  • Coverage is typically considered for individuals who have a high risk of fractures, particularly postmenopausal women and men who have tried and failed other therapies.
  •  

    Criteria for Coverage

     

    • The patient must have experienced an osteoporotic fracture or have multiple risk factors for fracture.
    •  

    • Prior treatment with other osteoporosis medications that were ineffective or unsuitable is usually required.

     

    Important Notes

     

    • Pre-authorization from Florida Blue may be necessary to ensure Forteo is covered under the individual’s health plan.
    •  

    • Coverage details can vary, so it is important to verify specific plan benefits directly with Florida Blue.

     

A weight management program tailored to you

Start with Curex

Why Florida Blue (Blue Cross Blue Shield of Florida) Might Deny Forteo Coverage

 

Approved Criteria for Forteo Coverage

 

  • Patient must be diagnosed with osteoporosis that meets the level of severity required for treatment with Forteo, indicating a high risk of fracture.
  •  

  • Patient should have a history of osteoporotic fracture(s) or multiple risk factors for fracture.
  •  

  • The patient must have had an insufficient response, or be intolerant, to previous osteoporosis therapy, such as bisphosphonates.
  •  

  • Patient should be postmenopausal women or men with primary or hypogonadal osteoporosis who meet the coverage criteria.
  •  

  • Patients undergoing treatment should be adults over the age of 18.
  •  

  • Medical documentation is required indicating the necessity of Forteo treatment, including pertinent medical history and response to prior therapies.
  •  

  • Request for coverage should be made by a healthcare provider with the proper credentialing, supporting the necessity of the Forteo therapy.
  •  

  • Ensure that the prescribed use aligns with FDA-approved indications for Forteo treatment.
  •  

 

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

Forteo FAQ

 

Situations When Florida Blue Might Deny Forteo Coverage

 

  • Forteo is not prescribed for an FDA-approved indication. This could include uses not recognized or not considered medically necessary per guidelines.
  •  

  • The individual has not met the necessary prerequisite treatment course. This often includes failing to try or respond to preferred medications that are less costly or more widely accepted by the policy.
  •  

  • Lack of documentation or insufficient information provided by the physician regarding the patient's condition. This might include missing details on the severity of osteoporosis or previous treatment history.
  •  

  • The patient's osteoporosis condition does not meet the severity criteria set by the insurer. For example, not having experienced a fracture or having a T-score that does not align with the insurer’s requirements.
  •  

  • Prescriptions written by out-of-network healthcare providers who are not recognized by Florida Blue’s network, unless circumstances warrant such an external prescription.

 

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.