(Risk Evaluation and Mitigation Strategy)

What is the NATPARA REMS Program?

A REMS Program is a strategy to manage known or potential serious risks associated with a drug product, and it is required by the FDA to ensure the benefits of a drug outweigh its risks. The NATPARA REMS Program informs prescribers, pharmacists, and patients about the potential risk of:

  • NATPARA causes an increase in the incidence of osteosarcoma in rats
  • The increase in osteosarcoma in rats is dependent on NATPARA dose and treatment duration


NATPARA is a parathyroid hormone indicated as an adjunct to calcium and vitamin D to control hypocalcemia in patients with hypoparathyroidism.

Because of the potential risk of osteosarcoma, NATPARA is only recommended for patients who cannot be well-controlled on calcium and active forms of vitamin D alone and for whom the potential benefits are considered to outweigh this potential risk.

NATPARA is not a parathyroid hormone replacement.

Program Requirements

NATPARA is only available through the NATPARA REMS Program.
The requirements include:

For Prescribers
  • Certification by completing training, including Knowledge Assessment, and enrollment into NATPARA REMS Program
  • Patient Counseling on benefits and risks of NATPARA
  • Completion of Patient-Prescriber Acknowledgment Form for each patient prior to initiation of treatment
  • Provide patient with a copy of the completed Patient-Prescriber Acknowledgment Form and the NATPARA Patient Brochure
For Pharmacies

Pharmacies must designate an authorized Pharmacy Representative who will complete the certification process on behalf of the pharmacy:

  • Certification by completing training, including the Knowledge Assessment, and enrolling into the NATPARA REMS Program
  • Implementing the necessary staff training and processes to comply with the NATPARA REMS Program requirements including:
    • Verifying that the prescriber is certified in NATPARA REMS Program
    • Verifying that a Patient-Prescriber Acknowledgment Form is on record for patient and prescriber

If you have any questions, contact the NATPARA REMS Program Coordinating Center at 1-855-NATPARA.