Does Gateway Health Plan Cover Forteo

Explore Gateway Health Plan's coverage for Forteo. Learn why coverage might be denied, how to secure it, Forteo costs without insurance, and more in our FAQ.
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“Curex is changing the landscape of allergies in 2024”
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Gateway Health Plan Coverage for Forteo

 

  • Forteo, a medication used to treat osteoporosis, may be covered by Gateway Health Plan under specific conditions.
  •  

  • Coverage is typically applicable for patients with a high risk of fracture, often those who have experienced multiple fractures or have failed to respond to other osteoporosis treatments.
  •  

  • Prior authorization may be required, meaning healthcare providers must demonstrate the medical necessity of Forteo for the patient.
  •  

  • Documentation of previous treatment attempts and their outcomes is crucial for approval.
  •  

  • Plan specifics vary, so contacting Gateway Health Plan directly for detailed coverage criteria and requirements is recommended.

 

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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 Gateway Health Plan

 

Contact Gateway Health Plan

 

  • Call the customer service number on your Gateway Health insurance card to verify if Forteo is covered under your policy.
  •  

  • Request a list of any necessary documentation needed to process a prescription for Forteo.

 

Confirm Prescription Requirements

 

  • Speak with your healthcare provider to ensure that Forteo is the right medication for you, given your medical history and condition.
  •  

  • Ask your doctor if prior authorization is required by Gateway Health Plan, which is a common requirement for specialty medications like Forteo.

 

Acquire Necessary Documentation

 

  • Obtain a prescription from your healthcare provider clearly stating the need for Forteo, including dosage and frequency.
  •  

  • Gather any additional documents that might be needed, such as medical history or specific test results, as advised by Gateway Health Plan.

 

Submit Prior Authorization

 

  • Work with your healthcare provider's office to submit a prior authorization request to Gateway Health Plan if required.
  •  

  • Ensure that all documentation required by Gateway is included with the prior authorization request for a smoother approval process.

 

Verify Coverage and Cost

 

  • After approval, confirm with Gateway Health Plan the details of your coverage for Forteo, including any co-pays, deductibles, and out-of-pocket expenses.
  •  

  • Discuss any potential cost-saving programs or discounts available through Gateway Health Plan or directly from the manufacturer of Forteo.

 

Fill Your Prescription

 

  • If possible, use a pharmacy within Gateway Health Plan's preferred network to potentially reduce costs and ensure coverage.
  •  

  • Arrange with the pharmacy for the receipt of Forteo, opting for home delivery if feasible and covered under your plan.

 

Follow Up

 

  • Stay in communication with both your healthcare provider and Gateway Health Plan to address any issues or questions about ongoing treatment with Forteo.
  •  

  • Regularly check for updates on coverage policies that could affect your prescription for Forteo.

 

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Does Gateway Health Plan Cover Forteo

Explore Gateway Health Plan's coverage for Forteo. Learn why coverage might be denied, how to secure it, Forteo costs without insurance, and more in our FAQ.
Curex allergy drops unboxing

Is Forteo Covered by Gateway Health Plan

 

Gateway Health Plan Coverage for Forteo

 

  • Forteo, a medication used to treat osteoporosis, may be covered by Gateway Health Plan under specific conditions.
  •  

  • Coverage is typically applicable for patients with a high risk of fracture, often those who have experienced multiple fractures or have failed to respond to other osteoporosis treatments.
  •  

  • Prior authorization may be required, meaning healthcare providers must demonstrate the medical necessity of Forteo for the patient.
  •  

  • Documentation of previous treatment attempts and their outcomes is crucial for approval.
  •  

  • Plan specifics vary, so contacting Gateway Health Plan directly for detailed coverage criteria and requirements is recommended.

 

A weight management program tailored to you

Start with Curex

Gateway Health Plan's Approved Criteria for Forteo Coverage

 

Coverage Criteria for Forteo under Gateway Health Plan

 

  • Forteo is covered for patients diagnosed with osteoporosis who are older adults at a high risk for fractures or have a history of osteoporotic fracture.
  •  

  • The patient must have either failed or be intolerant to other osteoporosis therapies such as bisphosphonates before qualifying for Forteo coverage.
  •  

  • Candidates should demonstrate a significantly decreased bone density, as validated by a bone density test such as a DEXA scan, corresponding to a T-score equal to or less than -2.5.
  •  

  • For patients with glucocorticoid-induced osteoporosis, they must have had a long-term usage (generally three months or more) of systemic glucocorticoids at a dose equivalent to 5 mg/day or greater of prednisone.
  •  

  • Patients with primary or hypogonadal osteoporosis should either be postmenopausal women or men aged 50 and older who have a heightened risk of fracture.
  •  

  • Authorization may be granted if there is documented evidence or physician attestation indicating that the patient has a severe form of osteoporosis requiring Forteo therapy.
  •  

  • Continuation of treatment beyond initial approval will require evidence of improvement such as stabilized or increased bone mineral density, absence of fractures, or clinical improvement as determined by the physician.

 

Why Gateway Health Plan Might Deny Forteo Coverage

 

Non-Medically Necessary Conditions

 

  • Gateway Health Plan may deny Forteo coverage if the treatment is deemed not medically necessary, meaning the patient's condition does not meet the severity or clinical criteria outlined for treatment with Forteo.

 

Lack of Prior Authorization

 

  • Coverage denial may occur if there has not been prior authorization obtained before prescribing Forteo. Gateway Health Plan requires prior approval to ensure that prescribed medications align with established guidelines.

 

Non-Approved Diagnosis

 

  • Forteo may not be covered if prescribed for a condition or diagnosis not approved by Gateway Health Plan. The medication is often restricted to specific conditions identified within their formulary guidelines.

 

Age Restrictions

 

  • Forteo may be denied for individuals outside the approved age range stipulated by Gateway Health Plan. Typically, the use of certain medications may be age-restricted based on clinical study data and guidelines.

 

Exceeding Duration Limits

 

  • Coverage may be denied if Forteo is being utilized beyond the duration limit set by Gateway Health Plan, such as continued use beyond the FDA-approved treatment duration.

 

Generic Alternatives Requirement

 

  • Denial might occur if a patient has not tried and failed alternative generic treatments, as some health plans require the use of lower-cost alternatives before approving coverage for more expensive medications like Forteo.

 

Non-Compliance with Protocols

 

  • Coverage can be denied if there is evidence of patient non-compliance with suggested treatment regimens or necessary health checks that accompany the prescription of Forteo.

 

Plan-Specific Exclusions

 

  • Gateway Health Plan may have specific exclusions within their member plan, precluding Forteo coverage due to plan limitations or exceptions not aligned with the drug's coverage policy.

 

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 Gateway Health Plan

 

Contact Gateway Health Plan

 

  • Call the customer service number on your Gateway Health insurance card to verify if Forteo is covered under your policy.
  •  

  • Request a list of any necessary documentation needed to process a prescription for Forteo.

 

Confirm Prescription Requirements

 

  • Speak with your healthcare provider to ensure that Forteo is the right medication for you, given your medical history and condition.
  •  

  • Ask your doctor if prior authorization is required by Gateway Health Plan, which is a common requirement for specialty medications like Forteo.

 

Acquire Necessary Documentation

 

  • Obtain a prescription from your healthcare provider clearly stating the need for Forteo, including dosage and frequency.
  •  

  • Gather any additional documents that might be needed, such as medical history or specific test results, as advised by Gateway Health Plan.

 

Submit Prior Authorization

 

  • Work with your healthcare provider's office to submit a prior authorization request to Gateway Health Plan if required.
  •  

  • Ensure that all documentation required by Gateway is included with the prior authorization request for a smoother approval process.

 

Verify Coverage and Cost

 

  • After approval, confirm with Gateway Health Plan the details of your coverage for Forteo, including any co-pays, deductibles, and out-of-pocket expenses.
  •  

  • Discuss any potential cost-saving programs or discounts available through Gateway Health Plan or directly from the manufacturer of Forteo.

 

Fill Your Prescription

 

  • If possible, use a pharmacy within Gateway Health Plan's preferred network to potentially reduce costs and ensure coverage.
  •  

  • Arrange with the pharmacy for the receipt of Forteo, opting for home delivery if feasible and covered under your plan.

 

Follow Up

 

  • Stay in communication with both your healthcare provider and Gateway Health Plan to address any issues or questions about ongoing treatment with Forteo.
  •  

  • Regularly check for updates on coverage policies that could affect your prescription for Forteo.

 

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 Gateway Health Plan Cover Forteo

Explore Gateway Health Plan's coverage for Forteo. Learn why coverage might be denied, how to secure it, Forteo costs without insurance, and more in our FAQ.
Curex allergy drops unboxing

Does Gateway Health Plan Cover Forteo

 

Gateway Health Plan Coverage for Forteo

 

  • Forteo, a medication used to treat osteoporosis, may be covered by Gateway Health Plan under specific conditions.
  •  

  • Coverage is typically applicable for patients with a high risk of fracture, often those who have experienced multiple fractures or have failed to respond to other osteoporosis treatments.
  •  

  • Prior authorization may be required, meaning healthcare providers must demonstrate the medical necessity of Forteo for the patient.
  •  

  • Documentation of previous treatment attempts and their outcomes is crucial for approval.
  •  

  • Plan specifics vary, so contacting Gateway Health Plan directly for detailed coverage criteria and requirements is recommended.

 

A weight management program tailored to you

Start with Curex

Why Gateway Health Plan Might Deny Forteo Coverage

 

Coverage Criteria for Forteo under Gateway Health Plan

 

  • Forteo is covered for patients diagnosed with osteoporosis who are older adults at a high risk for fractures or have a history of osteoporotic fracture.
  •  

  • The patient must have either failed or be intolerant to other osteoporosis therapies such as bisphosphonates before qualifying for Forteo coverage.
  •  

  • Candidates should demonstrate a significantly decreased bone density, as validated by a bone density test such as a DEXA scan, corresponding to a T-score equal to or less than -2.5.
  •  

  • For patients with glucocorticoid-induced osteoporosis, they must have had a long-term usage (generally three months or more) of systemic glucocorticoids at a dose equivalent to 5 mg/day or greater of prednisone.
  •  

  • Patients with primary or hypogonadal osteoporosis should either be postmenopausal women or men aged 50 and older who have a heightened risk of fracture.
  •  

  • Authorization may be granted if there is documented evidence or physician attestation indicating that the patient has a severe form of osteoporosis requiring Forteo therapy.
  •  

  • Continuation of treatment beyond initial approval will require evidence of improvement such as stabilized or increased bone mineral density, absence of fractures, or clinical improvement as determined by the physician.

 

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

Forteo FAQ

 

Non-Medically Necessary Conditions

 

  • Gateway Health Plan may deny Forteo coverage if the treatment is deemed not medically necessary, meaning the patient's condition does not meet the severity or clinical criteria outlined for treatment with Forteo.

 

Lack of Prior Authorization

 

  • Coverage denial may occur if there has not been prior authorization obtained before prescribing Forteo. Gateway Health Plan requires prior approval to ensure that prescribed medications align with established guidelines.

 

Non-Approved Diagnosis

 

  • Forteo may not be covered if prescribed for a condition or diagnosis not approved by Gateway Health Plan. The medication is often restricted to specific conditions identified within their formulary guidelines.

 

Age Restrictions

 

  • Forteo may be denied for individuals outside the approved age range stipulated by Gateway Health Plan. Typically, the use of certain medications may be age-restricted based on clinical study data and guidelines.

 

Exceeding Duration Limits

 

  • Coverage may be denied if Forteo is being utilized beyond the duration limit set by Gateway Health Plan, such as continued use beyond the FDA-approved treatment duration.

 

Generic Alternatives Requirement

 

  • Denial might occur if a patient has not tried and failed alternative generic treatments, as some health plans require the use of lower-cost alternatives before approving coverage for more expensive medications like Forteo.

 

Non-Compliance with Protocols

 

  • Coverage can be denied if there is evidence of patient non-compliance with suggested treatment regimens or necessary health checks that accompany the prescription of Forteo.

 

Plan-Specific Exclusions

 

  • Gateway Health Plan may have specific exclusions within their member plan, precluding Forteo coverage due to plan limitations or exceptions not aligned with the drug's coverage policy.

 

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.