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Does Sharp Health Plan Cover Forteo

Explore Forteo coverage under Sharp Health Plan, reasons for denial, steps to gain coverage, costs without insurance, and FAQ.

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Coverage for Forteo under Sharp Health Plan

Sharp Health Plan may cover Forteo for members diagnosed with severe osteoporosis who are at high risk for fractures and have not responded to other treatments.

Coverage usually requires prior authorization and is subject to the plan’s formulary and medical necessity review.

Patients often need documented history of fracture or low bone density scores.

Criterias often include a physician's prescription explicitly stating the medical necessity of Forteo.

For exact coverage details, members should consult their specific plan document or contact Sharp Health Plan directly for personalized assistance.

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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.

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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 Sharp Health Plan

Welcome to Sharp Health Plan

Visit the Sharp Health Plan website to learn about their coverage options. You may need to research the different plans they offer to find one suitable for your needs.

If you are not already a member, consider joining Sharp Health Plan by selecting the appropriate plan that meets your health and prescription needs. This may involve completing an application process.

Verify Your Prescription Needs

Confirm with your doctor that Forteo is the recommended treatment for your condition. Obtain any necessary documentation, such as a prescription or letter of medical necessity.

Gather any medical records that support the need for Forteo as part of your treatment plan.

Contact Sharp Health Plan Customer Service

Call Sharp Health Plan customer service to inquire about coverage specifics for Forteo. Request information on any forms or documents that may be required to process your coverage request.

Ask if there are specific pharmacies or suppliers you need to use to access Forteo under your plan.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request to Sharp Health Plan. This involves providing them with relevant medical documentation and the Forteo prescription.

Ensure all forms are filled out correctly and submitted through the channels indicated by Sharp Health Plan to avoid processing delays.

Follow Up and Monitor the Process

Keep in touch with your healthcare provider and Sharp Health Plan to track the status of your prior authorization request. Be proactive in addressing any additional information or documentation they may need.

Maintain a record of all communication with Sharp Health Plan and your provider for reference.

Review Benefits and Co-Pay Information

Once approval is obtained, review the coverage details with Sharp Health Plan, including any co-pays or out-of-pocket costs associated with Forteo.

Clarify any questions related to the duration of coverage and refill procedures to ensure uninterrupted access.

Pick Up or Receive Your Medication

Follow instructions provided by Sharp Health Plan on how to fill your Forteo prescription at an approved pharmacy or through mail order.

Verify that the prescription is covered under the terms discussed and that any co-pays are as expected before accepting the medication.

Maintain Ongoing Communication

Stay connected with Sharp Health Plan for any updates or changes in your coverage that could impact your access to Forteo.

Report any issues or concerns to both your healthcare provider and Sharp Health Plan to ensure your treatment remains consistent and effective.

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FAQs

Does Sharp Health Plan Cover Forteo

Explore Forteo coverage under Sharp Health Plan, reasons for denial, steps to gain coverage, costs without insurance, and FAQ.

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Is Forteo Covered by Sharp Health Plan

Coverage for Forteo under Sharp Health Plan

Sharp Health Plan may cover Forteo for members diagnosed with severe osteoporosis who are at high risk for fractures and have not responded to other treatments.

Coverage usually requires prior authorization and is subject to the plan’s formulary and medical necessity review.

Patients often need documented history of fracture or low bone density scores.

Criterias often include a physician's prescription explicitly stating the medical necessity of Forteo.

For exact coverage details, members should consult their specific plan document or contact Sharp Health Plan directly for personalized assistance.

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Sharp Health Plan's Approved Criteria for Forteo Coverage

Criteria for Forteo Coverage

Patient must have a confirmed diagnosis of osteoporosis with high risk for fracture based on clinical assessment and/or bone mineral density testing.

The patient should have experienced a previous osteoporotic fracture or multiple risk factors for fracture.

Treatment is appropriate for postmenopausal women with osteoporosis at high risk for fracture.

Men with primary or hypogonadal osteoporosis at high risk for fracture may also be considered for coverage of Forteo.

Forteo coverage may be available for individuals unable to use other osteoporosis treatments due to contraindications or intolerance.

Patients with a history of systemic or oral glucocorticoid therapy and are at high risk for fracture are eligible for coverage under certain conditions.

Duration and Renewal

Coverage for Forteo is typically approved for a total duration of 24 months, which is the maximum treatment period for this medication.

Renewal of Forteo therapy beyond 24 months is generally not recommended and may require special consideration on a case-by-case basis, demonstrating a continued high risk of fracture.

Prescriber's Role

The prescribing physician must be a specialist within the fields of rheumatology, endocrinology, or another relevant specialty for osteoporosis treatment.

All diagnosis and treatment plans should be well-documented, including evidence of prior treatments and their outcomes.

Why Sharp Health Plan Might Deny Forteo Coverage

Reasons Sharp Health Plan Might Deny Forteo Coverage

Forteo is not prescribed for an approved medical condition, such as severe osteoporosis with high fracture risk.

The patient has exceeded the lifetime duration limit for Forteo treatment, typically two years, due to safety concerns.

The patient does not meet the requisite diagnostic criteria or has failed to provide necessary documentation proving the need for Forteo.

Alternative osteoporosis treatments must be tried and deemed ineffective or contraindicated before Forteo is covered, and this documentation is missing or incomplete.

There is evidence of medication misuse or non-compliance by the patient, influencing Sharp Health Plan’s decision to deny coverage.

Sharp Health Plan might deny coverage in situations where the FDA approval status does not match the patient's need or diagnosis.

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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.

Clinical Support

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

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

Kayla Mardaga, NP

How to Get Forteo Coverage with Sharp Health Plan

Welcome to Sharp Health Plan

Visit the Sharp Health Plan website to learn about their coverage options. You may need to research the different plans they offer to find one suitable for your needs.

If you are not already a member, consider joining Sharp Health Plan by selecting the appropriate plan that meets your health and prescription needs. This may involve completing an application process.

Verify Your Prescription Needs

Confirm with your doctor that Forteo is the recommended treatment for your condition. Obtain any necessary documentation, such as a prescription or letter of medical necessity.

Gather any medical records that support the need for Forteo as part of your treatment plan.

Contact Sharp Health Plan Customer Service

Call Sharp Health Plan customer service to inquire about coverage specifics for Forteo. Request information on any forms or documents that may be required to process your coverage request.

Ask if there are specific pharmacies or suppliers you need to use to access Forteo under your plan.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request to Sharp Health Plan. This involves providing them with relevant medical documentation and the Forteo prescription.

Ensure all forms are filled out correctly and submitted through the channels indicated by Sharp Health Plan to avoid processing delays.

Follow Up and Monitor the Process

Keep in touch with your healthcare provider and Sharp Health Plan to track the status of your prior authorization request. Be proactive in addressing any additional information or documentation they may need.

Maintain a record of all communication with Sharp Health Plan and your provider for reference.

Review Benefits and Co-Pay Information

Once approval is obtained, review the coverage details with Sharp Health Plan, including any co-pays or out-of-pocket costs associated with Forteo.

Clarify any questions related to the duration of coverage and refill procedures to ensure uninterrupted access.

Pick Up or Receive Your Medication

Follow instructions provided by Sharp Health Plan on how to fill your Forteo prescription at an approved pharmacy or through mail order.

Verify that the prescription is covered under the terms discussed and that any co-pays are as expected before accepting the medication.

Maintain Ongoing Communication

Stay connected with Sharp Health Plan for any updates or changes in your coverage that could impact your access to Forteo.

Report any issues or concerns to both your healthcare provider and Sharp Health Plan to ensure your treatment remains consistent and effective.

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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.

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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 Sharp Health Plan Cover Forteo

Explore Forteo coverage under Sharp Health Plan, reasons for denial, steps to gain coverage, costs without insurance, and FAQ.

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