Product Details

Forteo

Teriparatide
250 mcg/mL
Solution for Injection
2.4-mL Prefilled Pen

DIN/PIN/NPN

09857535

Manufacturer

Eli Lilly Canada Inc.

Formulary Listing Date

2020-07-31  

Unit Price

1179.8500

Amount MOH Pays

565.2600

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02486423 Teva-Teriparatide Injection 565.2600 565.2600
09857535 Forteo 1179.8500 565.2600
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
676 2 years

For the treatment of osteoporosis in patients at a high risk of fragility fractures who meet ALL the following criteria:

  • 65 years of age or older; AND

  • Has a documented bone mineral density [BMD] T-score of less than or equal to 3;AND

  • Has a history of prior fragility fracture(s); AND

  • Has used an anti-resorptive agent for osteoporosis which resulted in osteonecrosis ofthe jaw and/or an atypical femur fracture.

Note: The maximum lifetime exposure to teriparatide for an individual patient is 24 months
 

EAP Criteria

NO

Product Monograph

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