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Does Tufts Health Plan Cover Forteo

Learn if Tufts Health Plan covers Forteo, reasons for denial, steps for approval, Forteo costs without insurance, and answers to common questions.

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Forteo Coverage by Tufts Health Plan

Forteo, a medication for osteoporosis, is typically covered under Tufts Health Plan with certain conditions and criteria.

Coverage is often available for patients with a high risk of fractures due to osteoporosis or a history of osteoporotic fractures.

To be eligible, patients might need to meet specific clinical criteria, such as previous treatment failure or intolerance to other osteoporosis therapies.

Authorization from a healthcare provider is generally required, ensuring the medication is medically necessary.

Members may need to provide evidence of bone mineral density (BMD) tests and detailed medical history to support the necessity of Forteo.

Coverage may vary based on the specific plan and member benefits, so reviewing the policy or consulting with a plan representative is advisable.

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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 Tufts Health Plan

Start by Reviewing Your Health Plan Benefits

Obtain a copy of your policy documents from Tufts Health Plan to understand the details of your prescription drug coverage.

Locate the section that outlines coverage for osteoporosis medications, specifically bone-building therapies like Forteo.

Consult Your Healthcare Provider

Discuss with your healthcare provider the need for Forteo treatment and obtain a prescription if medically necessary.

Ask your provider to provide supporting documentation or rationale explaining why Forteo is required for your treatment plan.

Contact Tufts Health Plan Member Services

Call the number on your Tufts Health Plan member ID card to speak with a representative about Forteo coverage.

Inquire about specific coverage requirements, such as prior authorization, step therapy, or if Forteo is included in the plan's formulary.

Submit a Prior Authorization Request

If prior authorization is required, work with your healthcare provider to submit a request to Tufts Health Plan along with the necessary medical documentation.

Ensure all paperwork is complete and submitted promptly to avoid coverage delays.

Understand Step Therapy Requirements

Some plans may require you to try other osteoporosis medications before approving Forteo. Confirm if this step therapy is needed.

Discuss alternative medications with your doctor if step therapy applies and ensure you follow the plan's guidelines.

Appeal a Denial if Necessary

If your request for Forteo coverage is denied, review the denial letter to understand the reasons and gather supporting materials to build a strong appeal.

Follow the appeals process outlined by Tufts Health Plan, submitting all necessary documentation promptly.

Consider Financial Assistance Programs

If Forteo is not covered or if you face high out-of-pocket costs, explore manufacturer assistance programs or other financial aid options.

Contact Forteo's manufacturer for information on patient assistance programs that may reduce costs.

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Does Tufts Health Plan Cover Forteo

Learn if Tufts Health Plan covers Forteo, reasons for denial, steps for approval, Forteo costs without insurance, and answers to common questions.

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Is Forteo Covered by Tufts Health Plan

Forteo Coverage by Tufts Health Plan

Forteo, a medication for osteoporosis, is typically covered under Tufts Health Plan with certain conditions and criteria.

Coverage is often available for patients with a high risk of fractures due to osteoporosis or a history of osteoporotic fractures.

To be eligible, patients might need to meet specific clinical criteria, such as previous treatment failure or intolerance to other osteoporosis therapies.

Authorization from a healthcare provider is generally required, ensuring the medication is medically necessary.

Members may need to provide evidence of bone mineral density (BMD) tests and detailed medical history to support the necessity of Forteo.

Coverage may vary based on the specific plan and member benefits, so reviewing the policy or consulting with a plan representative is advisable.

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Tufts Health Plan's Approved Criteria for Forteo Coverage

Criteria for Forteo Coverage

**Severe Osteoporosis Diagnosis** The patient must have a clinical diagnosis of severe osteoporosis indicated by a T-score of ≤ -2.5 or a history of osteoporotic fracture.

**Concurrent Risk Factors** The patient should demonstrate at least one additional risk factor for fracture, such as advanced age, low body mass index, history of smoking, or secondary osteoporosis.

**Inadequate Response or Intolerance to Other Therapies** The patient should have had an inadequate response to treatment with other osteoporosis medications like bisphosphonates or demonstrated intolerance to these therapies.

**Age Criteria** Typically, the patient should be postmenopausal or male patients should be over the age of 50, unless specific circumstances apply that warrant expedited treatment.

**Duration of Therapy** Coverage is typically provided for a duration consistent with FDA-approved labeling, often up to 24 months.

**Prescription by Specialist** The medication should be prescribed by or in consultation with a specialist, such as an endocrinologist, rheumatologist, or a healthcare provider experienced in osteoporosis management.

Why Tufts Health Plan Might Deny Forteo Coverage

Reasons for Denial of Forteo Coverage by Tufts Health Plan

Dose and Duration: Tufts Health Plan may deny coverage if the prescribed dose or duration of Forteo exceeds the guidelines set by the plan. Excessive dosing or use beyond the approved timeframe can result in denial.

Non-Approved Indications: Forteo may be denied if it is prescribed for conditions not covered under the plan's approved list of indications. Usage outside the approved scope usually results in non-coverage.

Incomplete Documentation: Lack of required medical documentation, such as detailed clinical history or failure to provide evidence of prior treatments, can lead to denial of coverage.

Step Therapy Requirements: If a patient has not attempted or demonstrated failure of alternative, cost-effective therapies as required by Tufts Health Plan's step therapy protocols, this could prompt a denial.

Lack of Medical Necessity: If the prescription does not meet the criteria for medical necessity as defined by Tufts Health Plan, coverage can be refused. This includes situations where the condition could be adequately managed with other, more conventional treatments.

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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 Tufts Health Plan

Start by Reviewing Your Health Plan Benefits

Obtain a copy of your policy documents from Tufts Health Plan to understand the details of your prescription drug coverage.

Locate the section that outlines coverage for osteoporosis medications, specifically bone-building therapies like Forteo.

Consult Your Healthcare Provider

Discuss with your healthcare provider the need for Forteo treatment and obtain a prescription if medically necessary.

Ask your provider to provide supporting documentation or rationale explaining why Forteo is required for your treatment plan.

Contact Tufts Health Plan Member Services

Call the number on your Tufts Health Plan member ID card to speak with a representative about Forteo coverage.

Inquire about specific coverage requirements, such as prior authorization, step therapy, or if Forteo is included in the plan's formulary.

Submit a Prior Authorization Request

If prior authorization is required, work with your healthcare provider to submit a request to Tufts Health Plan along with the necessary medical documentation.

Ensure all paperwork is complete and submitted promptly to avoid coverage delays.

Understand Step Therapy Requirements

Some plans may require you to try other osteoporosis medications before approving Forteo. Confirm if this step therapy is needed.

Discuss alternative medications with your doctor if step therapy applies and ensure you follow the plan's guidelines.

Appeal a Denial if Necessary

If your request for Forteo coverage is denied, review the denial letter to understand the reasons and gather supporting materials to build a strong appeal.

Follow the appeals process outlined by Tufts Health Plan, submitting all necessary documentation promptly.

Consider Financial Assistance Programs

If Forteo is not covered or if you face high out-of-pocket costs, explore manufacturer assistance programs or other financial aid options.

Contact Forteo's manufacturer for information on patient assistance programs that may reduce costs.

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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 Tufts Health Plan Cover Forteo

Learn if Tufts Health Plan covers Forteo, reasons for denial, steps for approval, Forteo costs without insurance, and answers to common questions.

Achieve Your Goals Faster with Curex