Limited coverage criteria – zoledronic acid

Last updated on March 24, 2025

 

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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

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)