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Need Forteo, covered by medicare?
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MSplusOsteoDealingWithIt posted:
Help!! Which Medicare drug plan covers Forteo? I just found out I have steroid-induced Osteoporosis and need Forteo, not Fosamax. Since I also have severe MS, try to walk with a walker (poor balance, severe muscle weakness & foot drag), but am prone to falling, I know any broken bones will cause me to need 24 hr assistance and will be life-changing. Condition is worsening since I am post-menopausal, can't do weight-bearing exercise, (can't stand or walk more than a few minutes per day), and MS drugs may attack bones. I am disabled & on Medicare, but current drug coverage denied Forteo. They require Prior Authorization and say that I need to try Fosamax for 2 years before Forteo, but my doctor says Forteo is not as effective once you have been on Fosamax. Anyone out there on Medicare getting Forteo? Please respond!
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bonebabe responded:
Contact the Eli Lilly Co. They'll know. I know that Medicare covers Forteo, but I don't know which plan. We have a good many patients on Forteo (with good results) who get it through Medicare. If you can't, Lilly can help you get it through their inhouse program.
 
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MSplusOsteoDealingWithIt responded:
Thanks for your reply, Beth. It's good to hear that Forteo gets good results and I should be able to get it on medicare. I had tried once to contact Lilly, but was unsuccessful in getting advice. Will try again if Forteo is not approved this time. Actually, I found out the Prior Authorization form needs to be re-submitted with more information, so I will pro-actively help fill it out and document my condition and complications, so I have no doubt it will be approved this time. Beth, maybe you could help me better understand my DEXA scan scores. The scans were done 2.5 yrs apart, but at the same clinic, interpreted by the same radiologist. The radiologist interpreted the lumbar spine value to decrease up to 2.3 percent change and the hips to decrease up to 13.7 percent change. In October, 2008, my DEXA scores were: T-Score for L1-L4: -1.9; Z-Score for L1-l4: -1.1; NECK: T-Score for left hip: -2.6; right hip: -2.4; Z-Score for left hip: -1.6; right hip: -1.3; TOTAL T-Score for the left hip: -3.3; right hip: -3.0; Z-Score for the right hip: -2.6; right hip: -2.3; These results were compared to those of April, 2004 T-Score for L1-L4: -1.7; Z-Score for L1-l4: -1.1; T-Score for left hip: -2.5; right hip: -2.2; Z-Score for left hip: -1.9; right hip: -1.6; For some background on what I know, my OB/GYN is concerned mostly that I have worsening osteoporosis since the hip scores of April 2004 should be compared to the TOTAL scores of Oct 2008 (i.e.T-Score left hip -2.5 worsening to -3.3, etc.). He said that they recently added the category NECK, so there was nothing to compare it to in the earlier scan. His treatment suggestion was Fosamax to stop the worsening osteoporosis. My osteo specialist is mostly concerned about drug-induced damage to my bones. He isn't as worried about progression as he is about repair. He compares the hip scores of 2006 to the NECK scores of 2008 (which doesn't indicate severe worsening), and says all the results point to Steroid-Induced osteoporosis. He isn't focused on worsening osteoporosis, but on repairing damage done to my bones by steroid treatments during my 30s and 40s, prescribing the bone-growth drug Forteo. I think that both doctors are right on - that my osteo is BOTH drug induced (IV steroids and Cytoxan to treat MS relapses/progression) AND worsening (I'm 53 years old, post-menopausal and can't walk or stand much) and I want to be very aggressive in treating it/keeping it from progressing. I just started on HRT for osteo and gyn. symptoms, and taking Calcium & Vit D3. I took two weeks of Fosamax when my osteo doctor said he wanted me to switch to Forteo, and I agree. A few last questions about the scores - do I use the TOTAL scores? Why are they so much higher (since negative, actually lower) than the NECK scores? I use my arms ALOT and also as weight bearing, as I push hard on my walker when my legs are weak. Will this weight bearing strengthen my arms relative to the other bones, such as hips? I depend so much on my arms to do ADL things, like standing up, rolling over in bed, lifting my legs to help me walk, driving - I hate to think that they are as much at risk as my legs, but my OB/GYN says osteo is a systemic disease and all the bones are bad. My left leg is weaker than my right and I favor it more, is this why the scores are worse for the left hip? I'm trying to do more standing and walking, but am nowhere near 4 hours per day. I use a walker in the house, but otherwise a power chair (due to MS disability). Thanks for any advice anyone out there has - I thank God I have found this site where real people take the time to help others with their health issues!
 
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bonebabe responded:
You're right about the drug induced osteoporosis. Steroids are just bad for bones. Your scores indicate that it is worsening which isn't surprising given your other complications. The neck of the hip is not a new site. It may be that on some software it's not used, but it should be regarded. It's the thin bone that connects the trochanter to the pelvis and the place most likely to fracture when bones are thinning. Current practice is to measure the neck each time, along with the total hip, but to report on the changes in the total hip. A calculation for measuring changes in the neck can be done, but isn't unless the total can't be measured. You are to be commended for doing everything you can to strengthen your hip and legs. The lack of weight bearing on your hip is what causes the rapid deterioration in a situation like yours. I think whatever you can do to put weight on your legs will help. Weight bearing on your arms won't help your hips. It's the action of the muscle pulling on the bone that stimulates growth. Disregard the Z-scores, they don't apply to you. They're for premenopausal women only. The Forteo will be wonderful for you. I certainly wish you success with this. Let me know if I can answer any more of your questions. Beth
 
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atokamom responded:
I will be finishing up my 2yrs of Forteo this mo. and have had good results. What should I take next to insure a carryover of the bone buildup?
 
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bonebabe responded:
Good for you. The standard course of treatment is to use the Forteo for 2 years, then follow with a bisphosphanate (Fosamax/Actonel/Boniva/Reclast) to strengthen the new bone. You should continue to get 1200 mg of calcium each day (taken several hours apart) and 1000 IU of Vitamin D.
 
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threeguysmom responded:
As a followup, how long can Fosamax and those type of drugs be taken? I am currently on an 18 month course of Forteo, but I am only 42 years old. When I finish up, I don't know if I should take another drug for the next 30 or 40 years. What do you think?
 
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bonebabe responded:
There's a lot of discussion about that. At age 42, you'll want to insure that your bones are strong for a very long time. Why 18 months of Forteo instead of the recommended 2 yrs? You'll need to take a bisphosphanate following the Forteo to strengthen the new bone. The current thinking is that if you have two consecutive bone density tests that show that you're either stable or increasing, you can go off the drugs as long as you remain stable. That would mean every 2 years having a test to determine this. Continue your 1200 mg of calcium and 1000 IU of Vit D each day to optimize your bone strength.


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