Comprehensive medication guide to Forteo including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$4/month for commercially insured patients with the Forteo savings card; Medicare Part D varies by plan with a $2,100 annual out-of-pocket cap in 2026; prior authorization required by most plans.
Estimated Cash Pricing
$3,100–$5,400 retail per pen (28-day supply) for brand Forteo; generic teriparatide as low as $1,146/pen with GoodRx or $1,524 with SingleCare coupons.
Medfinder Findability Score
45/100
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Forteo is the brand name for teriparatide, a prescription injectable medication used to treat severe osteoporosis in adults at high risk for fractures. It is manufactured by Eli Lilly and Company and was first FDA-approved in November 2002. FDA-approved generic teriparatide has been available since November 2023 from manufacturers including Teva and Apotex.
Teriparatide is a synthetic (recombinant) version of the first 34 amino acids of human parathyroid hormone (PTH 1-34)—the portion of PTH responsible for activating bone-building cells. It belongs to a drug class called parathyroid hormone analogs and is classified as an osteoanabolic agent, meaning it actively builds new bone tissue rather than merely slowing bone breakdown.
Forteo is FDA-approved for three indications: postmenopausal women with osteoporosis at high risk for fracture, men with primary or hypogonadal osteoporosis at high risk for fracture, and men and women with glucocorticoid-induced osteoporosis at high risk for fracture. Treatment is limited to a maximum of 2 years over a patient's lifetime.
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Forteo works by delivering a brief daily pulse of parathyroid hormone activity that stimulates osteoblasts (bone-building cells) to produce new bone. The key to its mechanism is intermittency: when PTH levels are continuously elevated (as in hyperparathyroidism disease), bone breakdown (resorption) dominates. But when PTH is present only as a brief daily spike—as Forteo's once-daily injection creates—bone formation dominates over resorption.
After subcutaneous injection, teriparatide reaches peak serum concentration in approximately 30 minutes and is cleared from the bloodstream within 3 hours. During this brief window, it binds to PTH1R receptors on osteoblasts and osteocytes, triggering signaling cascades that increase osteoblast survival, proliferation, and bone matrix (osteoid) production. This new matrix then mineralizes into denser, stronger bone.
Clinical studies have demonstrated that teriparatide can increase lumbar spine bone mineral density (BMD) by approximately 7–8% after one year of treatment, and significantly reduces the risk of vertebral and non-vertebral fractures. These effects are distinct from antiresorptive drugs (bisphosphonates, denosumab), which work by slowing bone breakdown rather than stimulating new bone formation.
20 mcg/dose — Subcutaneous injection, prefilled pen
560 mcg/2.24 mL prefilled pen; delivers 20 mcg per injection for 28 doses. Inject once daily into thigh or abdomen. Refrigerate at 2–8°C.
As of early 2026, Forteo is not listed on the FDA or ASHP drug shortage databases. Both brand Forteo and generic teriparatide are being actively manufactured and distributed. However, Forteo's specialty medication status, cold chain requirements, and insurance prior authorization hurdles create significant real-world access barriers for many patients.
Most standard retail pharmacies do not routinely stock Forteo because it must be refrigerated at 2–8°C and costs $3,100–$5,400 per pen. The medication is primarily dispensed through specialty pharmacies (CVS Specialty, Walgreens Specialty, Accredo, Optum Specialty) that have the cold chain infrastructure and handle specialty insurance logistics. Your insurance plan may also mandate a specific specialty pharmacy, adding coordination requirements.
If you're struggling to fill a Forteo prescription, medfinder can help. medfinder calls pharmacies near you to check which ones currently have Forteo or generic teriparatide in stock and texts you the results—eliminating the need to call pharmacies yourself. medfinder covers all medications, making it useful for any specialty prescription.
Forteo (teriparatide) is not a DEA-scheduled controlled substance, so there are no DEA prescribing restrictions. Any licensed prescriber with authority to prescribe injectable medications can write a Forteo prescription. In practice, the most common prescribers are specialists who manage osteoporosis and metabolic bone disease.
Endocrinologists: Most experienced with anabolic osteoporosis therapies; common first choice for complex cases
Rheumatologists: Frequently prescribe for glucocorticoid-induced osteoporosis in patients with inflammatory conditions
Primary care physicians (PCPs): Can prescribe Forteo with appropriate clinical documentation; may refer complex cases to specialists
Orthopedic surgeons: Often prescribe after fragility fractures; experienced with post-fracture bone health management
Geriatricians: Specialists in elderly care managing osteoporosis risk in older adults
Nurse Practitioners (NPs) and Physician Assistants (PAs): Can prescribe Forteo in most states with independent or collaborative prescribing authority
Telehealth prescribing is available for Forteo in 2026. Because teriparatide is not a controlled substance, there are no federal telehealth prescribing restrictions specific to it. A telehealth provider will still require current DEXA scan results and clinical history before prescribing. Several telehealth platforms connect patients with endocrinologists who specialize in osteoporosis management virtually.
No. Forteo (teriparatide) is not a DEA-scheduled controlled substance. There are no federal restrictions on who can prescribe it, how many refills can be dispensed, or how it can be transferred between pharmacies that specifically relate to controlled substance scheduling.
Any licensed prescriber with authority to prescribe injectable medications can write a Forteo prescription, including physicians (MDs and DOs), nurse practitioners (NPs), and physician assistants (PAs). Telehealth prescribing is also available without the restrictions that apply to scheduled controlled substances. The prescription limitations that do exist for Forteo—such as prior authorization and step therapy requirements—are imposed by insurance payers, not by DEA scheduling.
Most patients tolerate Forteo well. The following side effects occurred more frequently in teriparatide-treated patients than placebo during clinical trials:
Nausea (14%)
Orthostatic hypotension (dizziness when standing, especially with first doses)
Arthralgia (joint pain)
Leg cramps
Gastritis (7%)
Insomnia (5%)
Headache
Mild injection site reactions (redness, swelling, bruising)
Osteosarcoma (rare): Boxed warning based on rat studies; extremely rare in humans (est. 1 in 100,000); report persistent bone pain, unusual lumps, or unexplained swelling
Hypercalcemia: Transient calcium elevation post-injection; symptoms include nausea, vomiting, constipation, muscle weakness
Severe orthostatic hypotension: Lie down if fainting occurs after injection
Anaphylaxis (rare): Seek emergency care if severe allergic reaction occurs
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Abaloparatide (Tymlos)
Closest alternative to Forteo; daily subcutaneous injection PTHrP analog that builds new bone; room-temperature stable up to 30 days after opening (unlike Forteo which must stay refrigerated); brand only; similar mechanism
Romosozumab (Evenity)
Sclerostin inhibitor with dual action—builds bone AND inhibits resorption; monthly injection for 12 months; cardiovascular warning (avoid with recent MI/stroke); often shows greater BMD gains than teriparatide over 12 months
Denosumab (Prolia)
RANKL inhibitor; antiresorptive only (prevents bone loss, doesn't build new bone); injection every 6 months at provider's office; must not be abruptly discontinued (fracture rebound risk); no generic available
Alendronate (Fosamax)
Oral bisphosphonate; first-line antiresorptive therapy; generic widely available and affordable; typically required by insurance before anabolic agents like Forteo are approved; once-weekly dosing common
Prefer Forteo? We can find it.
Digoxin
majorForteo transiently raises serum calcium; elevated calcium sensitizes the heart to digoxin toxicity, potentially causing dangerous arrhythmias. Close monitoring required if combination is used.
Furosemide (Lasix)
moderateCoadministration causes small increases in serum calcium (~2%) and urinary calcium (~37%). Generally not clinically significant but monitoring is recommended.
Bisphosphonates (alendronate, risedronate, zoledronic acid)
moderateConcurrent use may blunt teriparatide's bone-building effect. Not recommended to use simultaneously. Sequential use (Forteo followed by bisphosphonate) is standard of care.
Hydrochlorothiazide (HCTZ)
minorThiazide diuretics reduce urinary calcium excretion; minor additive calcium effects with teriparatide; generally clinically insignificant.
Forteo (teriparatide) is one of the most powerful tools available for treating severe osteoporosis. Unlike antiresorptive drugs that merely slow bone loss, Forteo actively builds new bone—making it uniquely valuable for patients with very low bone density, multiple fractures, or inadequate response to first-line therapies. Its 2-year lifetime treatment limit, cold chain requirements, and high cost are real constraints, but they don't eliminate its clinical value for the right patients.
Access barriers are real but manageable in 2026. The Forteo copay card can reduce monthly costs to $4 for commercially insured patients. Generic teriparatide is now available and expanding in formulary coverage. The Lilly Cares Foundation PAP helps uninsured patients who qualify. And specialty pharmacies with home delivery take care of the cold chain logistics.
If you're having trouble finding Forteo at your pharmacy, medfinder can help locate pharmacies near you that have it in stock. medfinder handles the pharmacy calling for you, so you don't have to—and covers Forteo, generic teriparatide, and all other medications.
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