- Bone Loss Treatments:
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Drug Policy Based On: FDA Approved Indications
Diagnosis Types: 1 of All FDA-approved indications;Bone loss in men with non-metastatic Prostate Cancer receiving Anti-Androgen therapy;Bone metastases from solid tumors;Hypercalcemia defined as albumin-corrected serum Calcium >12.5mg/dl;Patients with Multiple Myeloma
Considered Investigational and Excluded from Coverage: Current treatment with Reclast
Required Medical Information: 3 of Calcium level;Chart Notes;Lab Results
Supporting Documentation Must Be Submitted: Yes
- Prior Authorization: Bone Loss Treatments:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
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