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Thursday, September 11, 2008 Terrie-Ann, Community Member, asks

Q: Is it true the out of pocket cost for Forteo is $10,000 for the full treatment

My husband is 30 and suffers Crohns, as a result of the steroid treatment and diabetes he has osteoporosis with a negative 2.5 T score. The specialist has asked us to consider Forteo but she has advised our out of pocket cost will be $10,000.

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Answers (2)
Pam Flores, Health Guide
9/11/08 12:19pm

Hi Terrie-Ann:  Does your insurance cover Forteo?  If not the retail price varies by location, and where I live it's about $700.00 a month.  So if you were to take it for 24 mos and had to pay retail the cost it would be $16,800.  Hopefully you don't have to pay retail and your insurance pays for some or all  of the cost.  If you are on a low income, you can get help from Eli Lily, by going to there web site or calling them.  Unfortunately your income has to be really low to qualify for the Lily Cares program, but it's worth looking into.  If you qualify, at Lily, you can then get Forteo for $25.00 a month.

 

Good luck on this, and also check the various prescription aids services to see if they will help for those without insurance coverage or whose insurances doesn't pay for Forteo.  Have you tried calling CuraScripts, don't know if they will help but it's worth a call.

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Pam Flores, Health Guide
9/12/08 12:04am

Hi Terrie-Ann:  I forgot to mention something, and wondered if you have insurance since the Dr is coming up with a figure that is less than full retail on Forteo.  A real easy way to find out how much it will cost is to call your insurance co. and ask if they cover Forteo, and if so, how much is the patients copay.  There are several other options I'm aware of for lowering the cost, but it depends on what type of insurance you have, and if they pay some portion of the price or not.  No need to mention your Ins Co name, but it would help to know what type of insurance you have to speculate on the price.

 

I have Medicare Part D and my carrier paid for most of the cost for the first year, which was a $60.00 copay a month for me, and they paid the balance.  At the beginning of the following year they changed the drug tier (classification) on Forteo and the copay went up to $175.00 a month.  I couldn't afford that, but since I'd completed the one year of tx already, my Dr. gave me sample pens to supplement the following year.  Most Dr.'s that rx Forteo have samples and they need to give them out before they expire, so their stock needs to be rotated by giving away what they have to make room for more new samples.  There's NO shame in asking for help, and that's what I did, and luckily I had a compassionate Dr who wasn't willing to have me stop the tx, since I was doing so well with it.  I improved from -3.6 spine, to normal bmd (-0.6) spine after 2 years.  I didn't have a hip score to compare to because I had a QCT instead of DXA, so now my hip score on DXA is in the very low osteopenia range.  I have no idea what it was when I had my first scan, but my scores were excellent from taking Forteo.

 

There is also an appeal process that all insurance co's have, where you can petition to have the drug classification lowered in copay/tier, or if they don't cover it at all, appeal the coverage status.  If you go this route, don't give up easily, because like they say the squeaky wheel gets the grease, so if you are turned down appeal again and again.

 

Good Luck...

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By Terrie-Ann, Community Member— Last Modified: 06/19/12, First Published: 09/11/08