Limited Coverage Drugs - Alendronate

Generic Name

alendronate, including in combination with cholecalciferol (Vitamin D3)


10 mg, 70 mg, 70 mg/5600 IU



Special Authority Criteria

Approval Period

Clinical or radiographically documented fracture due to osteoporosis


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.



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)