Starting FORTEO tomorrow and so nervous.

I think I might understand. Are you saying that the $8000 cap is all inclusive, not just the cost of the Forteo?

Hi babs10. Sorry it's taken me so long to get back to you.

The way my Medicare AARP UHC Plan D works for Forteo is:
Deductible phase: I pay the full cost of Forteo up to the deductible (which is $545), then I'm kicked into the Initial phase.

Initial phase: I pay a copay (or coinsurance) and the plan pays the rest. Net, my copay and what the plan pays together go towards the $5030 donut hole. Then I'm kicked into the Coverage Gap phase (or Donut Hole).

Coverage Gap Phase (Donut Hole): I pay 25% of the total cost until I reach $8000 (or Catastrophic Phase). Then I'm kicked into Catastrophic Phase.

Catastrophic Phase: I pay $0 cost.

For me I'm paying roughly $3327 full year for the cost . My plan payment by month will be April ($1550), May ($1166), June ($610), July-Dec ($0). Forteo is so expensive (retail $4633/mo) that I only pay out of pocket for the first three months.

I should note that my $3327 full year cost does not include pharmacy administrative fees or needles. I don't know what that cost is yet.

Yes, this is still expensive, however, I don't qualify for the various discounts through the manufacturer or other. After reading this string of comments from others, I will see if my doctor's office can provide any assistance with a better plan/cost. Thank you to everyone else for that insight!

If you haven't already done this, you should go to either Medicare.gov or your Plan D Anthem BC/BS and they should have an tool that will break this out based on your plan.

Just fyi, if I remember correctly, under the Inflammation Act signed by Biden, the Catastrophic Phase will be $2000 in 2025. Again, if I understand this correctly, all our out-of-pocket drug costs will be capped at $2000, then we pay $0. I may be wrong. I hope not (:->). But who knows what will happen in an election year.

I hope this helped.

Hi babs10. Sorry it's taken me so long to get back to you.

The way my Medicare AARP UHC Plan D works for Forteo is:
Deductible phase: I pay the full cost of Forteo up to the deductible (which is $545), then I'm kicked into the Initial phase.

Initial phase: I pay a copay (or coinsurance) and the plan pays the rest. Net, my copay and what the plan pays together go towards the $5030 donut hole. Then I'm kicked into the Coverage Gap phase (or Donut Hole).

Coverage Gap Phase (Donut Hole): I pay 25% of the total cost until I reach $8000 (or Catastrophic Phase). Then I'm kicked into Catastrophic Phase.

Catastrophic Phase: I pay $0 cost.

For me I'm paying roughly $3327 full year for the cost . My plan payment by month will be April ($1550), May ($1166), June ($610), July-Dec ($0). Forteo is so expensive (retail $4633/mo) that I only pay out of pocket for the first three months.

I should note that my $3327 full year cost does not include pharmacy administrative fees or needles. I don't know what that cost is yet.

Yes, this is still expensive, however, I don't qualify for the various discounts through the manufacturer or other. After reading this string of comments from others, I will see if my doctor's office can provide any assistance with a better plan/cost. Thank you to everyone else for that insight!

If you haven't already done this, you should go to either Medicare.gov or your Plan D Anthem BC/BS and they should have an tool that will break this out based on your plan.

Just fyi, if I remember correctly, under the Inflammation Act signed by Biden, the Catastrophic Phase will be $2000 in 2025. Again, if I understand this correctly, all our out-of-pocket drug costs will be capped at $2000, then we pay $0. I may be wrong. I hope not (:->). But who knows what will happen in an election year.

I hope this helped.

I think my insurance is similar and the $8000 is the catastrophic cap. I am having trouble getting Forteo approved still. I’m waiting for my endocrinologist to apply for an appeal.

Hi clairemcl, I'm meeting with my endo next week to review pre-Forteo tests and discuss next steps. I'm assuming this includes her prior approval for the insurance company. May I ask why your insurance is denying approval? In case I'm facing the same.

I have osteoporosis but have had no fractures and I have not tried other less expensive drugs. I have severe scoliosis and spinal stenosis and found out about the osteoporosis when the spine doctor recommended surgery. I can’t have surgery without the bone building, hence Forteo.

clairemcl, oh my gosh. I see your issue. I would think given your spine issues and the need for surgery would be enough to satisfy insurance. I'll keep my fingers crossed for you.

I have been on alendronate (generic fosamax) with little benefit. My endo is focused on stronger bone building meds (Forteo/Tymlos) since I'm only 66.