Limited Coverage Drugs - Special Authority Criteria
Generic Name / Strength / Form
risedronate 5mg & 35mg
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.
- No practitioner exemptions
- 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.