Limited Coverage Drugs - Alendronate

Generic Name

alendronate, including in combination with cholecalciferol (Vitamin D3)

Strength

10 mg, 70 mg, 70 mg/5600 IU

Form

tablet

Special Authority Criteria

Approval Period

Clinical or radiographically documented fracture due to osteoporosis

OR

Glucocorticoid-induced osteoporosis in patients who are receiving or expected to receive the equivalent dose of 7.5 mg of prednisone per day or greater AND for 90 consecutive days or longer.

Indefinite

 

1 year

Practitioner Exemptions

  • None

Special Notes

  • Clinical fracture is defined as a symptomatic (painful) fracture.
  • Radiographically documented fracture is defined as a fracture identified by X-ray (e.g., vertebral compression fracture). This may be asymptomatic.
  • Coverage is intended for patients taking glucocorticoids with significant systemic absorption only (e.g., by oral or parenteral routes).

Special Authority Request Form(s)