Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form

risedronate 5mg & 35mg

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

  • No practitioner exemptions

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 (i.e., by oral or parenteral routes).

Special Authority Request Form(s)

Online Forms (PDF, 523KB)
Click on the link to complete a special authority request form.