Prior Authorization : Preferred Drug List

Bone Resorption Suppression Drugs

Note: The Preferred Drug List Quick Reference provides the most current list of preferred and non-preferred drugs in this drug class.

Teriparatide (Generic Bonsity)

Teriparatide (generic Bonsity) requires clinical PA.

PA requests for teriparatide (generic Bonsity) must be completed, signed, and dated by the prescriber. PA requests for teriparatide (generic Bonsity) must be submitted using Section VI (Clinical Information for Drugs With Specific Criteria Addressed in the ForwardHealth Online Handbook) of the PA/DGA form.

The PA form must be sent to the pharmacy where the prescription will be filled. The prescriber may send the PA form to the pharmacy, or the member may carry the PA form with the prescription to the pharmacy. The pharmacy provider will use the completed PA form to submit a PA request to ForwardHealth. Prescribers should not submit the PA form to ForwardHealth.

Pharmacy providers are required to submit the completed PA/DGA form and a completed PA/RF to ForwardHealth.

PA requests for teriparatide (generic Bonsity) may be submitted on the Portal, by fax, or by mail (but not using the STAT-PA system).

For information about general ForwardHealth PA policy for drugs that require PA approval, prescribers and pharmacy providers may refer to the Standard Pharmacy Policy for Covered and Noncovered Drugs topic. Providers may also refer to this topic for information about what may not be considered criteria to support the need for a drug.

Clinical Criteria for Teriparatide (Generic Bonsity)

The clinical criteria that must be documented for approval of a PA request for teriparatide (generic Bonsity) includes both of the following:

• The prescriber has submitted detailed clinical justification for prescribing teriparatide (generic Bonsity) instead of Forteo.
• The clinical information must document why the member cannot use Forteo including why it is medically necessary that the member receive teriparatide (generic Bonsity) instead of Forteo.

Clinical documentation and medical records must be submitted with the PA request to support the need for teriparatide (generic Bonsity). PA requests for teriparatide (generic Bonsity) may be approved for up to 365 days.