Limited coverage criteria – zoledronic acid

Last updated on March 24, 2025

Special Authority requests can now be submitted online. It's simple and quick!

Generic name	zoledronic acid
Strength & form	5 mg / 100 ml intravenous solution

Special Authority criteria	Approval period
For women with postmenopausal osteoporosis or men with osteoporosis AND A clinical or radiographically documented fracture due to osteoporosis AND Contraindication to oral bisphosphonates due to abnormalities of the esophagus that delay esophageal emptying (e.g., stricture or achalasia)	Indefinite

Special Authority criteria

Approval period

For women with postmenopausal osteoporosis or men with osteoporosis

AND

A clinical or radiographically documented fracture due to osteoporosis

AND

Contraindication to oral bisphosphonates due to abnormalities of the esophagus that delay esophageal emptying (e.g., stricture or achalasia)

Indefinite

Practitioner exemptions

None

Special notes

The Special Authority request must include details about the patient’s contraindication to oral bisphosphonates
Clinical fracture is a symptomatic (painful) fracture
Radiographically documented fracture is a fracture identified by x-ray (e.g., vertebral compression fracture). This may be asymptomatic

Special Authority request form(s)

Log in to eForms
HLTH 5328 – General Special Authority request (PDF, 656KB)

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