Forteo Medicare Coverage

When it comes to managing osteoporosis Forteo is a common prescription that doctors recommend. But if you’re on Medicare understanding your coverage options for this medication can feel like navigating a maze blindfolded. Here at Medicare Advisors Insurance Group LLC we’re here to help you get a handle on your Forteo coverage so you don’t have to lose any sleep over it. Well not more than usual anyway.

Does Medicare Cover Forteo?

The short answer is: Yes. But as with everything related to Medicare, it’s never that simple. Forteo (teriparatide) is covered under Medicare Part D but there’s a bit more to the story.

How Does Medicare Part D Cover Forteo?

Medicare Part D plans cover prescription medications but each plan is different. Forteo is usually on the formulary (the list of covered drugs) of most Part D plans, but where it’s placed on the formulary can affect your out-of-pocket costs. Generally, Forteo is classified as a “specialty tier” drug. That’s a fancy way of saying it could cost you an arm and a leg. Not literally of course that’s what Forteo is supposed to help you avoid.

What’s the Cost of Forteo Under Medicare?

Now let’s talk about what everyone really wants to know: “How much is this going to cost me?” Unfortunately, specialty drugs like Forteo can be expensive even with Medicare. Depending on your plan you might be looking at paying 20% to 33% of the cost after you hit your deductible. Ouch right?

• Deductibles: Some Part D plans have a deductible you need to meet before they start covering medications. Once you hit that you’ll still be responsible for a copayment or coinsurance.
• Coverage Gap: Also known as the “donut hole.” Once you and your plan have spent a certain amount of money on covered drugs you enter the coverage gap. During this time you might pay a higher percentage for your drugs until you hit the catastrophic coverage threshold.
• Catastrophic Coverage: After you’ve spent enough to get out of the coverage gap Medicare will kick in and you’ll only pay a small coinsurance or copayment for the rest of the year. But it’s a long and costly road to get there.

Are There Any Alternative Coverage Options for Forteo?

Let’s say you’re thinking, “There’s got to be a cheaper way to get Forteo right?” You’re not alone in that thought. There are a few other ways you might be able to save some cash.

Medicare Advantage Plans

Some Medicare Advantage plans (also known as Part C) may offer additional benefits beyond what Original Medicare provides including coverage for prescription drugs. But here’s the kicker: these plans vary widely. Henry Beltran owner of Medicare Advisors Insurance Group LLC points out, “Medicare Advantage plans are like snowflakes; no two are alike.” You’ll want to check with your plan to see if Forteo is covered and at what cost.

Patient Assistance Programs

Drug manufacturers sometimes offer patient assistance programs for those who can’t afford their medications. Eli Lilly the maker of Forteo has such a program. Of course, there are eligibility requirements and paperwork involved because nothing in life is ever that easy.

Supplemental Coverage

If you’re really worried about the cost consider getting a Medicare Supplement plan (also known as Medigap). These plans help cover some of the out-of-pocket costs that Medicare doesn’t cover like copayments and coinsurance. But watch out they don’t cover drugs so you’d still need a separate Part D plan.

Potential Drawbacks of Using Forteo

While Forteo can be a game-changer for those with osteoporosis it’s not all sunshine and rainbows. There are some potential drawbacks to keep in mind—and we’re going to highlight them with a bit of humor because why not?

High Cost

As we’ve already touched on Forteo is expensive. It’s like paying for a luxury car but instead of getting a sleek sports car, you get a tiny vial of medication. Just imagine telling your friends you spent thousands of dollars on something you can’t even drive.

Daily Injections

Forteo is administered via a daily injection. Yep, every single day. If you’re not a fan of needles this could be a dealbreaker. It’s like having a porcupine as a pet—cute in theory but painful in practice.

Side Effects

As with any medication, Forteo comes with a list of potential side effects. Common ones include nausea dizziness and leg cramps. It’s like your body’s way of saying, “I see what you’re doing, and I’m not sure I like it.”

In Conclusion

Navigating the world of Medicare coverage for Forteo can be tricky but it’s not impossible. Here at Medicare Advisors Insurance Group LLC, we’re dedicated to helping you understand your options and make the best choice for your health and your wallet.

Henry Beltran says “The key is to educate yourself and don’t be afraid to ask for help.” Whether that’s comparing Medicare Part D plans looking into Medicare Advantage or checking out patient assistance programs there’s a solution out there for you.

FAQs

How can I find out if my plan covers Forteo?

You can check your plan’s formulary or call the number on the back of your Medicare card for more information.

What if I can’t afford Forteo even with Medicare?

Look into patient assistance programs or talk to your doctor about alternative treatments.

Is there a generic version of Forteo?

Not currently but always check with your pharmacist for the most up-to-date information.