Limited Use Note(s)

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TERIPARATIDE250mcg/mL Inj Sol-2.4mL Pref Pen
Reason For Use CodeClinical Criteria
676For 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 of the jaw and/or an atypical femur fracture. Note: The maximum lifetime exposure to teriparatide for an individual patient is 24 months
LU Authorization Period: 2 years