Limited coverage criteria – romosozumab

 

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Generic name		romosozumab
Strength & form		105 mg/1.17 mL pre-filled syringe

Special Authority criteria

Approval period

For the treatment of osteoporosis in postmenopausal women who: Have sustained an osteoporotic fracture AND Are at high risk for future fracture, defined as 10-year fracture-risk ≥ 20% as defined by the Fracture Risk Assessment (FRAX) tool AND Are treatment naive to osteoporosis medications, except for calcium and/or vitamin D AND Will not be prescribed other osteoporosis medications concurrently with romosozumab, except for calcium and/or vitamin D

Up to 12 months1

Practitioner exemptions

• None

Special notes

• The maximum duration of coverage is 12 months. Coverage for retreatment with romosozumab will not be provided
• If patient has had any romosozumab therapy prior to being approved for coverage by PharmaCare, it is expected that the total duration of therapy does not exceed 12 months
• PharmaCare covers a maximum of 30 days of romosozumab per fill
• PharmaCare coverage is limited to 210 mg of romosozumab monthly

Special Authority request form(s)

• Log in to eForms
• HLTH 5853 – Romosozumab (PDF, 465KB)