CurrentUnitedHealthcarePolicy N/A

Step therapy for teriparatide (Forteo) and generic teriparatide

This program governs prior authorization and step-therapy requirements for Forteo (teriparatide) and generic teriparatide, requiring trial of preferred alternatives (including Tymlos and brand teriparatide where applicable) before coverage; applies to UnitedHealthcare pharmacy benefits and affected members.

Policy Summary

PayerUnitedHealthcare

PolicyStep therapy for teriparatide (Forteo) and generic teriparatide

Policy CodePolicy N/A

Change TypeAnnual review (no material change)

Effective DateMay 1, 2025

Next Review DateFeb 1, 2025

Key ActionObtain prior authorization and document history of failure, contraindication, or intolerance to preferred products (brand teriparatide and Tymlos) before requesting coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

24 moauthorization duration

2 yrslifetime limit

Step therapyprogram type

NCapplicable state

Coverage Criteria

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A. Osteoporosis

Forteo and generic teriparatide will be approved when ALL of the following are met:

Osteoporosis criteria: (1) Patient sex and diagnosis: EITHER (a) patient is female AND diagnosis of postmenopausal osteoporosis OR (b) patient is male AND diagnosis of osteoporosis; (2) History of failure, contraindication, or intolerance to Brand Teriparatide Injection; AND (3) History of failure, contraindication, or intolerance to Tymlos (abaloparatide).

Authorization will be issued for 24 months.

B. Osteoporosis associated with sustained systemic glucocorticoid therapy

Forteo and generic teriparatide will be approved when BOTH of the following are met:

Glucocorticoid-induced osteoporosis: (1) Diagnosis of glucocorticoid-induced osteoporosis; AND (2) History of failure, contraindication, or intolerance to Brand Teriparatide Injection.

Other Diagnoses

For other diagnoses, approval requires:

Other diagnoses: History of failure, contraindication, or intolerance to Brand Teriparatide Injection.

Forteo (teriparatide) and generic teriparatide are excluded from coverage for the majority of UnitedHealthcare benefits. Plan-specific benefit designs may vary, so providers should confirm exclusion status with the member’s specific plan prior to initiating therapy.

Some formularies and benefit plans implement tried-and-failed (step) criteria for Forteo/teriparatide; members who do not meet these criteria may be denied coverage. UnitedHealthcare may use automated approval logic based on prior claims, medication history, and diagnosis codes (ICD-10), so approval behavior can vary by program and plan — verify requirements and any applicable prior authorization or documentation rules before prescribing.

Coding

Codes referencedmixed

ICD-10

Diagnosis codes may be used for automated approvals; specific ICD-10 codes not listed in document

Cumulative lifetime duration: teriparatide and abaloparatide

Recommended cumulative lifetime durationUse of teriparatide (Forteo/brand or generic) or abaloparatide (Tymlos) for more than 2 years during a patient’s lifetime is not recommended.

Supporting guideline recommendationAACE (American Association of Clinical Endocrinologists/American College of Endocrinology) recommends limiting treatment with abaloparatide and teriparatide to 2 years.

Authorization considerationReauthorization and continuation decisions should consider cumulative lifetime exposure limits and are typically issued for 24 months per authorization rules.

Provider Actions and Requirements

Prior Authorization

Prior Authorization Required

Prior authorization required. Coverage for Forteo (teriparatide) and generic teriparatide requires documentation that the member has failed, has a contraindication to, or is intolerant of preferred therapies (including Brand Teriparatide Injection and Tymlos where specified). Authorization is typically issued for 24 months; plan-specific exclusions and federal/regulatory requirements may affect coverage.

Authorization duration: 24 months (when approved)
Forteo and teriparatide are typically excluded from coverage for the majority of benefits — verify plan specifics

Step Therapy

Step Therapy Requirement

Step therapy applies: members must try preferred products before coverage is provided for Forteo/teriparatide. For postmenopausal or male osteoporosis indications, approval requires documented failure, contraindication, or intolerance to Brand Teriparatide Injection and to Tymlos (abaloparatide) where specified. For glucocorticoid‑induced osteoporosis and other diagnoses, documented failure/contraindication/intolerance to Brand Teriparatide Injection is required.

Postmenopausal osteoporosis: failure/contraindication/intolerance to Brand Teriparatide Injection and Tymlos (abaloparatide) required
Male osteoporosis: same failure/contraindication/intolerance requirements as above
Glucocorticoid‑induced osteoporosis: failure/contraindication/intolerance to Brand Teriparatide Injection required

Documentation Required

Documentation and Automated Approval

UnitedHealthcare may approve initial or reauthorization requests based on previous claim or medication history, diagnosis codes (ICD‑10), and/or automated claim logic. Use of these automated approval and re‑approval processes varies by program and therapeutic class. Medical necessity, supply limits, and notification rules may also apply.

Automated approval may rely on prior claims/medication history and ICD‑10 codes
Use of automated processes varies by program/therapeutic class
Medical necessity and supply limits may still be enforced

Denial Risk

Denial Triggers

Denials may occur if step therapy or tried‑and‑failed criteria are not met, if required documentation is missing, or if the member's benefit plan excludes Forteo/teriparatide. Verify plan‑specific exclusions as Forteo is excluded from coverage for the majority of benefits.

Coverage may be denied when required failure/contraindication/intolerance criteria are not met
Denial if documentation or required prior authorization is missing
Denial when member benefit plan specifically excludes Forteo/teriparatide

Background

Teriparatide (Forteo and generics) and abaloparatide (Tymlos) are parathyroid hormone analogs indicated to increase bone mass and reduce fracture risk in men and postmenopausal women with osteoporosis and for glucocorticoid‑induced osteoporosis. Product labeling and clinical guidance recommend limiting cumulative use of teriparatide or abaloparatide to about 2 years over a patient’s lifetime, and authorizations issued by UnitedHealthcare are typically for 24 months.

Definitions

High risk for fracture (definition)

DefinitionHigh risk for fracture is defined as a history of osteoporotic fracture or multiple risk factors for fracture (per product labeling).

Contexts referencedDefinition applied to postmenopausal osteoporosis, primary or hypogonadal osteoporosis in men, and glucocorticoid-induced osteoporosis indications.

Glucocorticoid thresholdGlucocorticoid-induced osteoporosis refers to sustained systemic glucocorticoid therapy (daily prednisone equivalent ≥ 5 mg) with high fracture risk defined as above.

Initial Therapy Criteria

Initial therapy

Initial authorization criteria

Initial therapy: See Coverage.criteria_sets: require appropriate diagnosis (per A or B above or other approved diagnosis) and documented history of failure, contraindication, or intolerance to Brand Teriparatide Injection and to Tymlos (abaloparatide) where specified by the indication.

Authorization will be issued for 24 months for initial approval.

Continuation Therapy Criteria

Continuation therapy

Reauthorization/continuation rules

Reauthorization: Authorization issued for 24 months; continuation should consider cumulative lifetime exposure limits — use of teriparatide or abaloparatide beyond 2 years total lifetime is not recommended.24 months authorization

Federal regulatory requirements and member-specific benefit plan coverage may also impact coverage; other policies/utilization management programs may apply.

Step Therapy Requirements

Step	Required prior therapy (preferred products)	Notes
1	Trial of brand teriparatide (Forteo or Brand Teriparatide Injection)	Member must have history of failure, contraindication, or intolerance to brand teriparatide before coverage of generic teriparatide/Forteo.
2	Trial of abaloparatide (Tymlos)	Step through Tymlos is required for osteoporosis in men (added in 2/2023 update). Member must have history of failure, contraindication, or intolerance to Tymlos.