Forteo

A few words about Forteo (recombinant human PTH[1-34], also called teriparatide).

• In the United States, Forteo is approved for the treatment of osteoporosis.  It comes with a black box warning about the risk of osteosarcoma (which is well known to users of Natpara).  Forteo’s use is restricted to two years.
• The cost of Forteo has increased over the last few years and is now around $30,000 per year.  It is self-administered with a pen and comes only in one strength; each shot contains 20 mcg of Forteo (which, on a molar basis, is similar to 45 mcg Natpara).
• Forteo is produced by Lilly.  Its patent ran out in August 2019, and it is, therefore, possible that another company will start producing generic teriparatide.  When a patent runs out and the drug is produced as a generic, often (but not always) prices go down dramatically. Currently, there is no generic teriparatide approved or available in the US.
• Different insurance companies handle the authorization of Forteo for patients with hypoparathyroidism differently.  Some approve it without prior authorization (PA).  Others require PA, detailed patient information, and the reason for the use.  Some approve it; others do not.
• If the transition to Forteo is desired, the patient should call the insurance and ask if it is covered. Another way to find out if your insurance company will approve Forteo is to have your endocrinologist write a script for Forteo and send it to your pharmacy.  It is advisable that you call your pharmacist as they have to enter the request.  You will find out if your insurance needs a PA or not.  If it does, you will have to tell your endocrinologist’s office so that they can initiate the PA.