Medicare AdvantagePrior AuthMedium impact
Forteo® (teriparatide injection) (Revised)
Humana·Endocrinology, Rheumatology, Orthopedics +3 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana revised its Medicare Advantage prior authorization policy for Forteo (teriparatide injection) for osteoporosis treatment, with new risk stratification criteria including 'VERY HIGH risk' categories and updated approval requirements. The policy is effective January 1, 2026 and includes specific criteria for postmenopausal, glucocorticoid-induced, and primary/hypogonadal osteoporosis.
Action Required
By January 1, 2026: Update prior authorization protocols for Forteo (teriparatide) prescriptions for Medicare Advantage patients. Ensure documentation includes osteoporosis diagnosis, fracture risk assessment (high vs very high risk), previous treatment failures/intolerances, T-scores, FRAX scores, and glucocorticoid use details. Train clinical staff on new 'very high risk' criteria including recent fractures, T-scores <-3.0, and FRAX scores >30% major osteoporotic fracture or >4.5% hip fracture. Note 2-year maximum treatment duration and contraindications including Paget's disease and prior radiation.