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Does SummaCare Cover Forteo

Explore SummaCare's Forteo coverage, potential denial reasons, costs without insurance, and FAQs to ensure you get the treatment you need efficiently.

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Does SummaCare Cover Forteo?

SummaCare may cover Forteo, primarily for patients with osteoporosis who are at a high risk for fractures. This often includes postmenopausal women, men with primary or hypogonadal osteoporosis, and those with glucocorticoid-induced osteoporosis.

The coverage often requires the patient to have had previous fractures or a significant decline in bone density despite being on other osteoporosis medications.

A doctor's prescription and pre-authorization are usually necessary to verify medical necessity and ensure coverage.

Patients must meet specific criteria defined by SummaCare, which may include age, medical history, and response to prior treatments.

Costs depend on the plan specifics, so it's essential to contact SummaCare directly for detailed information regarding coverage and associated patient costs.

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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 SummaCare

Determine Your Eligibility

Contact SummaCare customer service to confirm your current plan benefits and eligibility for coverage of Forteo (teriparatide).

Review your Summary of Benefits and Coverage (SBC) document, which can often be accessed through SummaCare's online portal.

Consult with Your Healthcare Provider

Speak with your doctor to ensure that Forteo is the appropriate medication for your condition. This will often involve a detailed medical assessment.

Request your healthcare provider to write a prescription for Forteo, noting any justification or medical necessity required by insurance providers.

Check Prescription Drug Formulary

Access SummaCare's formulary list via their website or through their customer service. Determine if Forteo is listed as a covered medication.

If Forteo is not on the formulary, discuss alternative medications with your doctor or inquire about the possibility of a formulary exception with SummaCare.

Prior Authorization Requirements

Contact SummaCare to check if Forteo requires a prior authorization. This will likely involve a form that your healthcare provider must complete.

Collaborate with your doctor to submit all required documentation to SummaCare for prior authorization. Ensure all paperwork includes necessary medical justification.

Appeal a Denial if Necessary

If your initial request for Forteo coverage is denied, review the denial letter for specific reasons and the appeals process outlined by SummaCare.

Work closely with your healthcare provider to gather additional documentation supporting the medical need for Forteo, then submit an appeal.

Utilize SummaCare Resources

Log in to SummaCare's member portal for additional tools and information that might assist in managing your claim for Forteo coverage.

Reach out to a SummaCare case manager or patient advocate who may provide support or guidance through the coverage process.

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FAQs

Does SummaCare Cover Forteo

Explore SummaCare's Forteo coverage, potential denial reasons, costs without insurance, and FAQs to ensure you get the treatment you need efficiently.

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Is Forteo Covered by SummaCare

Does SummaCare Cover Forteo?

SummaCare may cover Forteo, primarily for patients with osteoporosis who are at a high risk for fractures. This often includes postmenopausal women, men with primary or hypogonadal osteoporosis, and those with glucocorticoid-induced osteoporosis.

The coverage often requires the patient to have had previous fractures or a significant decline in bone density despite being on other osteoporosis medications.

A doctor's prescription and pre-authorization are usually necessary to verify medical necessity and ensure coverage.

Patients must meet specific criteria defined by SummaCare, which may include age, medical history, and response to prior treatments.

Costs depend on the plan specifics, so it's essential to contact SummaCare directly for detailed information regarding coverage and associated patient costs.

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SummaCare's Approved Criteria for Forteo Coverage

Criteria for Forteo Coverage

Forteo is covered for patients with a confirmed diagnosis of osteoporosis, determined by a bone density test score (T-score) of -2.5 or lower, at the lumbar spine, total hip, or femoral neck. Additionally, a history of osteoporotic fracture or multiple risk factors for fracture may be required.

Candidates for Forteo treatment should have a history of an inadequate response to or contraindication for other osteoporosis therapies.

Patients should be male or female, age 18 or older, meeting specific clinical guidelines and presenting with significant fracture history or T-score indications.

Patient Monitoring Requirements

Regular follow-up through bone density tests or clinical evaluation to ensure treatment efficacy and safety.

Periodic assessment of serum calcium and renal function during the course of treatment is required.

Authorized Prescribers

Forteo must be prescribed by or in consultation with a specialist in endocrinology, rheumatology, or a physician with expertise in osteoporosis management.

Why SummaCare Might Deny Forteo Coverage

Situations Where SummaCare Might Deny Forteo Coverage

Forteo is not covered if used for conditions that are not approved by the FDA. This includes any off-label uses.

Coverage may be denied if the patient does not meet the specific pre-authorization criteria outlined by SummaCare.

Forteo may not be covered if there is evidence of non-compliance with prior therapies or treatment plans specified by healthcare providers.

Requests for Forteo may be rejected if the patient’s medical documentation does not sufficiently demonstrate the necessity of treatment according to SummaCare’s guidelines.

Coverage could be denied if the patient's osteoporosis treatment exceeds the recommended duration set by SummaCare.

If there are cost-effective alternatives covered under the plan, Forteo coverage might be denied.

Claims may be denied for Forteo if it is not listed on the formulary or if the patient's healthcare plan excludes it as a covered item.

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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 SummaCare

Determine Your Eligibility

Contact SummaCare customer service to confirm your current plan benefits and eligibility for coverage of Forteo (teriparatide).

Review your Summary of Benefits and Coverage (SBC) document, which can often be accessed through SummaCare's online portal.

Consult with Your Healthcare Provider

Speak with your doctor to ensure that Forteo is the appropriate medication for your condition. This will often involve a detailed medical assessment.

Request your healthcare provider to write a prescription for Forteo, noting any justification or medical necessity required by insurance providers.

Check Prescription Drug Formulary

Access SummaCare's formulary list via their website or through their customer service. Determine if Forteo is listed as a covered medication.

If Forteo is not on the formulary, discuss alternative medications with your doctor or inquire about the possibility of a formulary exception with SummaCare.

Prior Authorization Requirements

Contact SummaCare to check if Forteo requires a prior authorization. This will likely involve a form that your healthcare provider must complete.

Collaborate with your doctor to submit all required documentation to SummaCare for prior authorization. Ensure all paperwork includes necessary medical justification.

Appeal a Denial if Necessary

If your initial request for Forteo coverage is denied, review the denial letter for specific reasons and the appeals process outlined by SummaCare.

Work closely with your healthcare provider to gather additional documentation supporting the medical need for Forteo, then submit an appeal.

Utilize SummaCare Resources

Log in to SummaCare's member portal for additional tools and information that might assist in managing your claim for Forteo coverage.

Reach out to a SummaCare case manager or patient advocate who may provide support or guidance through the coverage process.

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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.

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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 SummaCare Cover Forteo

Explore SummaCare's Forteo coverage, potential denial reasons, costs without insurance, and FAQs to ensure you get the treatment you need efficiently.

Achieve Your Goals Faster with Curex