Forteo costs vary widely depending on your specific Medicare plan and pharmacy

Forteo (teriparatide) is an injectable medication for osteoporosis that Medicare covers, but your out-of-pocket cost depends on which plan you have, which pharmacy you use, and whether you meet your deductible. Most people with Original Medicare Part B pay a percentage of the cost after meeting their annual deductible, while those in Medicare Advantage plans pay whatever their plan specifies — which can range from a copay of $35 to $150 per month or more. The actual wholesale price of Forteo is roughly $4,000 to $5,000 per month before any insurance discount, but you will not pay that amount if you have Medicare coverage.

The most direct way to find your exact cost is to call your pharmacy with your Medicare card number and ask what you would pay for a one-month supply of Forteo. Prices differ between pharmacies, so calling two or three is worth the time. You can also log into your plan's website or call the plan's customer service line to see whether Forteo is on your formulary (the list of covered drugs) and what tier it sits on — higher tiers mean higher copays.

Key Takeaways

  • Original Medicare Part B covers Forteo after you meet your annual deductible, then you typically pay 20 percent of the cost.
  • Medicare Advantage plans cover Forteo but set their own copays and deductibles, so costs vary by plan and can be lower or higher than Original Medicare.
  • Calling your pharmacy directly with your Medicare information is the fastest way to learn your actual out-of-pocket cost.
  • Patient information programs run by the manufacturer may reduce your cost if you meet income limits, even if you have Medicare.

How Original Medicare Part B covers Forteo

Under Original Medicare Part B, Forteo is covered as a self-administered injectable drug, which means Medicare pays its share after you have met your Part B deductible for the year. Once your deductible is satisfied, you pay 20 percent of the Medicare-approved amount, and Medicare pays 80 percent. The Medicare-approved amount is not the full pharmacy price — it is a negotiated rate that is typically lower than the list price.

Your deductible resets every January 1st. If you have not yet met it when you start Forteo, your first few months of medication will count toward that deductible. Once you reach the deductible amount, the 20 percent coinsurance kicks in for the rest of the year. This means your cost per injection will be predictable once you have met the deductible, but the total amount you pay in the first few months depends on when in the year you start the medication.

Medicare Advantage plans and Forteo copays

Medicare Advantage plans (Part C) are required to cover at least as much as Original Medicare does, but each plan decides its own copay amounts and deductibles. Some Advantage plans charge a flat copay per Forteo injection — commonly $35 to $75 — while others use coinsurance (a percentage of cost) like Original Medicare. A few plans may require prior authorization, meaning your doctor must get approval from the plan before the pharmacy fills your prescription.

Because Forteo is an injectable specialty medication, it may sit on a higher formulary tier in your Advantage plan, which translates to a higher copay than a standard drug would have. Check your plan's formulary document or call the plan directly to confirm Forteo is covered and what your copay will be. If your plan does not cover Forteo, you have the right to switch to a different Medicare Advantage plan or return to Original Medicare during the annual enrollment period (October 15 to December 7).

Pharmacy choice and price differences

Forteo prices vary between pharmacies, even for the same insurance plan. A large chain pharmacy, an independent pharmacy, and a specialty pharmacy may all quote different costs for the same medication. Specialty pharmacies — which focus on injectable and complex medications — sometimes offer lower prices for Forteo because they handle high volumes of this drug.

Your doctor's office may have a preferred pharmacy or may send the prescription to a default location. You are not required to use that pharmacy. Ask your doctor if they have a preference, but you can also request the prescription be sent to the pharmacy with the lowest price for your plan. Some Medicare plans have preferred pharmacy networks that offer lower copays, so check your plan documents before choosing where to fill the prescription.

Manufacturer information and other cost-reduction options

Eli Lilly, the manufacturer of Forteo, runs a patient information program that may reduce your cost if your household income falls below certain limits. The program is called the Lilly Cares Foundation, and it can provide Forteo at no cost or at a reduced price depending on your financial situation. You can reach them at 1-800-545-5979 or visit their website to learn whether you may be may be able to access.

Some state pharmaceutical information programs also help cover the cost of Forteo for older adults who meet income and asset limits. These programs vary by state, so contact your state health department or search for "[your state] pharmaceutical information program" to see what is available where you live. If you are struggling to afford Forteo even with Medicare, mentioning this to your doctor may open other options — they sometimes have samples or know of additional resources.

What happens if Forteo is not covered or costs too much

If your Medicare plan does not cover Forteo or the copay is unaffordable, you have several paths forward. First, ask your doctor whether a different osteoporosis medication might work for you — some alternatives like alendronate (Fosamax) are available as oral pills and may have lower copays. Second, you can request a coverage exception from your plan, which asks the plan to cover a drug that is not on the formulary or to lower the copay tier. Your doctor must submit this request, and the plan has a set number of days to respond.

Third, if you are in a Medicare Advantage plan, you can switch to Original Medicare during the annual enrollment period and potentially find a lower cost that way. Fourth, the manufacturer information program mentioned above does not require you to have a certain type of insurance — it looks at your household income, so even if Medicare covers part of the cost, Lilly Cares may cover the rest if you may have access to.

Frequently Asked Questions

Does Medicare cover Forteo injections at home?

Yes. Medicare Part B covers Forteo as a self-administered injectable, meaning you inject it yourself at home. You do not need to go to a doctor's office for the injection. Your doctor will show you how to use the pen, and you will receive the medication through a pharmacy.

Will my copay change if I use a mail-order pharmacy?

Possibly. Some Medicare plans offer lower copays through mail-order or specialty pharmacies, while others charge the same regardless of where you fill the prescription. Check your plan's formulary or call customer service to compare costs before choosing a pharmacy.

What if I cannot afford the copay even with Medicare?

Contact the Lilly Cares Foundation at 1-800-545-5979 to see if you may have access to for manufacturer information. You can also ask your doctor about alternative osteoporosis medications with lower copays, or request a coverage exception from your Medicare plan to lower the tier.

Does Forteo cost the same every month?

Yes, under most Medicare plans your copay will be the same each month once you have met your deductible. The exception is if you switch pharmacies or plans, or if your plan changes its formulary during the year — though plans typically notify you of major changes in advance.

Can I switch Medicare plans to get a lower Forteo copay?

Yes, during the annual enrollment period (October 15 to December 7) you can switch from one Medicare Advantage plan to another, or from Advantage back to Original Medicare. Compare Forteo costs across plans before the enrollment period ends to find the lowest option for you.