Does Security Health Plan Cover Forteo? A Woman's Complete Guide to Teriparatide Insurance Coverage

What Is Forteo and Why Do Women Need It More Than Men?

Forteo is the brand name for teriparatide, a 34-amino-acid fragment of human parathyroid hormone given as a once-daily subcutaneous injection of 20 mcg. Unlike bisphosphonates, which slow bone breakdown, teriparatide actually builds new bone by stimulating osteoblast activity. That anabolic mechanism makes it one of the most effective agents available for women with severe osteoporosis.

Women account for roughly 80 percent of the 10 million Americans with osteoporosis, and the sex difference is not accidental. Estrogen actively suppresses osteoclast activity. When estrogen falls at menopause, bone resorption accelerates sharply. Women can lose up to 20 percent of bone density in the five to seven years immediately following their final menstrual period, a window during which fracture risk rises faster than most realize.

How Teriparatide Works in the Female Skeleton

Bone is not a static structure. It cycles through resorption and formation throughout life, a process tightly coupled to estrogen signaling. In postmenopausal women, this coupling breaks down, and resorption outpaces formation.

Teriparatide binds PTH1 receptors on osteoblasts and temporarily uncouples the system in the other direction, pushing formation ahead of resorption. The FORTEO fracture prevention trial (FPT) showed a 65 percent relative risk reduction in new vertebral fractures and a 53 percent relative risk reduction in nonvertebral fragility fractures compared with placebo in postmenopausal women over an 18-month median follow-up. These are among the largest fracture-reduction effect sizes of any osteoporosis drug.

Which Women Are Candidates?

The FDA label approves teriparatide for postmenopausal women with osteoporosis at high risk for fracture, defined as a T-score at or below -2.5, a prior fragility fracture, or multiple risk factors. It is also approved for women with glucocorticoid-induced osteoporosis and for men, though the male data is a smaller dataset. Premenopausal women with severe, documented osteoporosis may qualify under some Security Health Plan plans, but approval criteria are stricter and require stronger justification from your prescriber.

How Security Health Plan Formularies Work for Specialty Drugs

Security Health Plan is a Wisconsin-based regional insurer offering commercial, Medicare Advantage, and Medicaid-related products. Like most U.S. Health plans, it organizes drugs into a tiered formulary. Forteo lands in the specialty tier, which carries the highest cost-sharing.

Formulary Tiers and What They Mean for Your Copay

Specialty drugs at Security Health Plan typically fall in Tier 4 or Tier 5. Your out-of-pocket cost before meeting your deductible can range from several hundred to over a thousand dollars per month without assistance. The list price of Forteo is approximately $3,000 to $3,500 per monthly pen, making manufacturer copay assistance programs critical for most commercially insured women.

Security Health Plan's formulary is updated annually on January 1. A drug that was covered on your plan in a prior year may move to a different tier, require new authorization, or face new step-therapy requirements. Always pull your current plan's formulary document, not a cached version from a prior year.

Medicare Advantage Plans Through Security Health Plan

If you are 65 or older and enrolled in a Security Health Plan Medicare Advantage product, Forteo coverage falls under Part D drug benefits. Medicare Part D plans are required to cover at least two drugs in each therapeutic category, and teriparatide is generally included. However, cost-sharing at the specialty tier for Medicare beneficiaries can still be substantial until the Medicare out-of-pocket cap of $2,000 per year (effective 2025 under the Inflation Reduction Act) applies.

The WomanRx Prior-Authorization Readiness Framework for Forteo gives you a step-by-step checklist your prescriber can use before submitting to Security Health Plan:

1. Obtain a dual-energy X-ray absorptiometry (DXA) scan within the past 24 months showing a T-score at or below -2.5 at the spine, hip, or femoral neck, or document a low-trauma fracture.
2. Document a trial of a bisphosphonate (alendronate, risedronate, zoledronic acid) of at least 12 months, or provide clinical documentation of a contraindication or intolerance (esophageal disease, renal impairment with GFR <35 mL/min, hypersensitivity).
3. Include serum calcium, vitamin D 25-OH level, and renal function labs dated within the past 6 months.
4. If the indication is glucocorticoid-induced osteoporosis, document the steroid dose (typically prednisone 5 mg/day or equivalent for 3 or more months) and duration.
5. For premenopausal women, provide menstrual history, reproductive status, and endocrine workup ruling out secondary causes.
6. Submit a letter of medical necessity co-signed by your prescriber that references the American College of Rheumatology (ACR) 2022 guideline for glucocorticoid-induced osteoporosis or the Endocrine Society 2019 guideline on osteoporosis pharmacotherapy as appropriate.

Step Therapy: The Bisphosphonate Hurdle

Security Health Plan, like most commercial insurers, applies step therapy to anabolic agents. Step therapy means you must try (and document) a less expensive drug before the plan will pay for a more expensive one. For Forteo, that first-line step is almost always a bisphosphonate.

What Counts as a Failed Bisphosphonate Trial?

A failed trial generally means one of three things. You took a bisphosphonate for the required duration (often 12 months) and continued to lose bone or sustained a fracture while on therapy. You developed a documented adverse effect such as severe esophagitis, osteonecrosis of the jaw related to a prior IV bisphosphonate, or atypical femoral fracture. Or you have a medical contraindication, most often renal impairment, because bisphosphonates are not recommended when estimated GFR falls below 30 to 35 mL/min.

Your prescriber's letter needs to be explicit. Vague language like "patient did not tolerate" is frequently rejected. Specific language like "patient developed grade 2 esophagitis requiring proton pump inhibitor escalation after 4 months of weekly alendronate 70 mg" gives the plan's medical reviewer a clear clinical picture.

Denosumab as an Alternative Step

Some Security Health Plan formularies accept prior denosumab (Prolia) use in place of, or in addition to, bisphosphonate step therapy. If you have already been on denosumab and are transitioning because of inadequate response or jaw osteonecrosis risk concerns, ask your prescriber to document that history explicitly in the PA request.

Prior Authorization: The Process Step by Step

The prior authorization process at Security Health Plan for Forteo typically follows this sequence.

Your prescriber submits a PA request, usually electronically through the plan portal or via fax with a PA form. Security Health Plan has up to 72 hours for standard requests and 24 hours for expedited urgent requests under most state-regulated plans. Wisconsin state law aligns with these timeframes.

A clinical reviewer (typically a pharmacist or nurse) does an initial screen against the plan's clinical criteria. If the criteria are clearly met, approval is issued. If documentation is insufficient or step therapy is not demonstrated, the plan issues a denial or a request for additional information.

If denied, you have the right to a peer-to-peer review, where your prescriber speaks directly with the plan's reviewing physician. This step converts denials at a meaningful rate. One analysis published in Health Affairs found that peer-to-peer calls overturned initial PA denials in roughly 75 percent of cases for specialty drugs when the clinical case was well-documented.

If the peer-to-peer still results in a denial, you can file a formal internal appeal and, if that fails, an external appeal through Wisconsin's Office of the Commissioner of Insurance.

Pregnancy, Lactation, and Contraception: What Every Woman Must Know

Forteo is contraindicated in pregnancy. Full stop.

Pregnancy Category and Human Data

Teriparatide carries FDA Pregnancy Category C under the older system, but the updated Pregnancy and Lactation Labeling Rule (PLLR) language on the current label states that animal studies showed skeletal abnormalities in offspring at doses above the human dose, and there are no adequate, well-controlled studies in pregnant women. The drug should not be used during pregnancy. If you are of reproductive age and receiving Forteo, your prescriber should confirm reliable contraception before initiating treatment.

The evidence gap here is real: no randomized trial has enrolled pregnant women, and case reports of inadvertent exposure are too few to draw safety conclusions. This is an area where data in women is genuinely thin, and the precautionary position reflects that uncertainty.

Lactation

There are no human data on teriparatide transfer into breast milk. Animal studies suggest it is present in milk. The FDA label advises against use during breastfeeding. Given the drug's anabolic effects on bone and the absence of infant safety data, current clinical guidance is to avoid teriparatide while nursing.

Premenopausal Women Receiving Forteo

Premenopausal women who need teriparatide for severe glucocorticoid-induced osteoporosis or other documented indications must use effective contraception throughout the treatment course. Discuss contraceptive options with your prescriber before starting. Oral contraceptives, intrauterine devices, and barrier methods are all used in this clinical context; the right choice depends on your other health conditions.

Life Stage Matters: Coverage and Clinical Context Across Reproductive Life

Reproductive Years

Osteoporosis in reproductive-age women is less common but not rare, particularly in women with anorexia nervosa, amenorrhea-associated bone loss (the female athlete triad), or prolonged glucocorticoid use. Security Health Plan may cover Forteo for premenopausal women in these scenarios, but expect more documentation requests and a higher bar for the letter of medical necessity.

Perimenopause

Bone loss accelerates in perimenopause before the final menstrual period, sometimes by 1 to 2 percent per year at the spine. Menopausal hormone therapy (MHT) is the first-line consideration for bone preservation in perimenopausal women, and most plans will not cover Forteo unless osteoporosis (not osteopenia) is established and other agents have been tried. MHT is not an FDA-approved osteoporosis treatment in isolation, though the Menopause Society supports its use for bone protection in recently menopausal women.

Postmenopause

This is the primary approved indication. Security Health Plan is most likely to cover Forteo in women who are postmenopausal with a T-score at or below -2.5 plus a fragility fracture, or at or below -3.0 even without a prior fracture, after a documented bisphosphonate trial. The National Osteoporosis Foundation (NOF) FRAX-based threshold of a 10-year major osteoporotic fracture probability at or above 20 percent or a hip fracture probability at or above 3 percent also supports pharmacologic treatment and can be cited in PA documentation.

Post-Forteo Sequencing

Teriparatide's anabolic gains are not permanent if you stop the drug without transitioning to an antiresorptive. The DATA-Switch trial showed that bone gains from teriparatide were best preserved by switching to denosumab immediately after the 24-month course. Your prescriber should plan sequencing before you start, and both drugs should be documented in the PA plan when coverage for Forteo is sought, so your plan is aware of the full treatment strategy.

Cost Assistance When Coverage Falls Short

Even with Security Health Plan coverage, your copay at the specialty tier can be prohibitive.

Eli Lilly Manufacturer Assistance

Eli Lilly offers the Lilly Cares Foundation Patient Assistance Program for uninsured and underinsured patients who meet income requirements, providing Forteo at no or reduced cost. For commercially insured patients, Lilly's Forteo copay card can reduce out-of-pocket costs significantly, though it cannot be used alongside Medicare or Medicaid.

State Pharmaceutical Assistance Programs

Wisconsin residents 65 and older may qualify for SeniorCare, Wisconsin's prescription drug program for seniors, which can layer with Medicare to reduce specialty drug costs further.

Appeals and Exceptions

If your appeal of a Security Health Plan denial is successful, the plan must cover the drug retroactively to the date of the initial request in most cases. Keep records of every submission date, every phone call with a name and reference number, and every piece of documentation you send.

Who This Treatment Is Right For and Who Should Think Twice

Women Who Are Strong Candidates

You are likely a strong candidate for Forteo coverage approval through Security Health Plan if you are postmenopausal with a T-score at or below -2.5, have experienced at least one low-trauma fracture (a wrist fracture from a fall from standing height counts), have documented intolerance or contraindication to bisphosphonates, and have a prescriber prepared to write a detailed letter of medical necessity that references published guidelines.

Women on long-term glucocorticoid therapy (prednisone 5 mg/day or more for 3 or more months) with a T-score at or below -2.5 are also strong candidates under ACR 2022 guidelines.

Women Who Should Discuss Alternatives First

Forteo is not appropriate if you have a history of bone metastases, prior radiation therapy to the skeleton, Paget's disease of bone, or unexplained elevated alkaline phosphatase. Women with hypercalcemia should not use teriparatide. Women with a personal or family history of osteosarcoma face a label-level precaution, though the FDA removed the black box warning for osteosarcoma in 2020 after long-term postmarketing surveillance did not confirm an elevated risk in humans at therapeutic doses.

Women with mild to moderate osteoporosis (T-score between -1.0 and -2.5, no fracture, lower FRAX probability) are better served by bisphosphonates as initial therapy both clinically and from an insurance-coverage standpoint.

Working With Your Prescriber to Maximize Approval Odds

The single most important factor in getting Security Health Plan to approve Forteo is the quality of your prescriber's documentation. A generic template PA form rarely succeeds for a specialty anabolic agent. What works is a narrative letter that ties your specific DXA results, fracture history, prior drug trials, and comorbidities to the plan's stated clinical criteria and to published guideline thresholds.

Ask your prescriber to use language from the Endocrine Society 2019 clinical practice guideline, which states: "We recommend anabolic therapy as initial treatment for patients with severe osteoporosis" and defines severe as a T-score at or below -2.5 with one or more fragility fractures or a T-score at or below -3.0. That language, cited explicitly, gives the plan's medical reviewer a recognized authority to agree with rather than an individual clinical judgment to override.

Ask your pharmacist to call Security Health Plan's specialty pharmacy coordinator on the same day the PA is submitted. A pharmacist's clinical peer-to-peer is sometimes faster than waiting for a denial and then appealing.

If you are self-managing a complex coverage situation, the Patient Advocate Foundation's Case Management Services offers free help navigating insurance denials for serious conditions including osteoporosis.