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

• Patients who meet the above criteria for osteoporosis for alendronate automatically receive coverage for both alendronate and risedronate
• 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)

• Log in to eForms
• HLTH 5328 - Special Authority Request (PDF, 656KB)