| Anthem Blue Cross (HMO, PPO, EPO) |
| Evenity (romosozumab-aqqg) |
| Hormones : Drugs for Menopause and Bone Loss |
- Step Therapy Applies
- PA Applies
- Available only through Specialty Pharmacy;
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;
- Prior Authorization: Osteoporosis: Post Menopausal Women:
Documented Diagnosis: Yes
Gender Requirement: Female
Duration: 1 year(s)
- Osteoporosis: Post Menopausal Women:
Duration: 1 year(s)
Gender Requirement: Female
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
History of Fracture Required: Variable
USA specific WHO fracture (FRAX) assessment criteria positive: Variable
BMD T-score at neck, total hip, or lumbar spine: <= -3
Self-Administration Allowed: No
Multiple fractures required: No
Documented Diagnosis: Yes
- Quantity Limit: 2 syringes per 30 day(s).
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