Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form

risedronate 30mg

Criteria Approval Period

Diagnosis of Paget's disease
an adequate trial of etidronate that has failed to reduce symptoms and/or has not reduced levels of alkaline phosphatase


Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • Adequate trial is defined as at least two months of etidronate therapy.

Special Authority Request Form(s)

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