Anthem Blue Cross (HMO, PPO, EPO) |
Zometa (zoledronic acid-mannitol-water) |
Hormones : Drugs for Menopause and Bone Loss |
- Bone Loss Treatments:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Specialty Pharmacy Provider(s): 1 of Accredo Health Group, Inc.;Apothecary By Design;Circle Care;The Pharmacy at Maine Medical Center
Reauthorization Required: No
Duration of Reauthorization: N/A
Drug Policy Based On: 1 of FDA Approved Indications;NCCN Guidelines
Diagnosis Types: 1 of Bone loss in men with non-metastatic Prostate Cancer receiving Anti-Androgen therapy;Bone loss in women with Breast Cancer receiving Aromatase Inhibitor therapy;Bone metastases from solid tumors;Cancer Treatment-Induced Bone Loss (CTIBL);Hypercalcemia of Malignancy;Patients with Multiple Myeloma
Considered Investigational and Excluded from Coverage: all other conditions
Supporting Documentation Must Be Submitted: No
- Prior Authorization: Bone Loss Treatments:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Available only through Specialty Pharmacy;
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