Does Medicare Cover Forteo? 

Caring for your bone health may not be at the top of your to-do list when you wake up in the morning, but as you get older, it’s vital to make sure your bones are strong and healthy. Diseases like osteoporosis can rob your body of the minerals and calcium needed to maintain strong bones, and this can mean painful fractures and breaks as a result of physical trauma.

According to the Osteoporosis and Bone Foundation, osteoporosis affects around 10 million women and men each year in the United States. It’s also estimated that over 40 million people suffer from low bone density in the United States, and many of these people are seniors. Although women are disproportionately affected by osteoporosis due to menopause, this condition can lead to weakened bones in both men and women starting around age 50.

What causes Osteoporosis?

Osteoporosis is a medical condition in which the body reabsorbs calcium and vitamin D instead of sending these nutrients to the bones. Over time, osteoporosis leads to weak and brittle bones that are more susceptible to breaks and fractures.

Osteoporosis has a number of causes, including age, post-menopause estrogen depletion in women and poor diet. In some cases, osteoporosis can be treated by changing your diet, but in others, medications like Forteo may be needed to stop bone loss and strengthen bones.

What is Forteo?

Forteo (teriparatide) is a prescription medication designed to provide relief from the effects of osteoporosis. The medication is injected by the patient, usually at home. Forteo is a synthetic hormone known as parathyroid. The body usually makes this hormone on its own to strengthen bones, but age, menopause and other factors can affect the body’s ability to produce and utilize parathyroid. 

Although Forteo was designed to treat osteoporosis in postmenopausal women, it can be used to treat men and women who have developed osteoporosis as a result of glucocorticoid drug treatments. Prednisone is an example of a commonly prescribed glucocorticoid medication that, over time, may lead to the development of osteoporosis.

Does Medicare cover Forteo?

Medicare benefits may cover Forteo under Medicare Part D, the outpatient benefit. Medicare Part D is the add-on prescription drug portion of Medicare that was added into the program in 2006. Medicare Part D only pays for medications that are purchased from a retail pharmacy and taken at home. Forteo does not receive coverage from this portion of Medicare insurance because it has to be administered via injection in a provider’s office.

If you have Original Medicare, you can enroll in a stand-alone Prescription Drug Plan (PDP), or alternatively, you can enroll in a Medicare Advantage plan that includes prescription drug coverage (MA-PD).