- Quantity Limit: 1 vial per 28 day(s).
- Bone Loss Treatments:
Age Requirement: >= 18
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Specialty Pharmacy Provider(s): Accredo Health Group, Inc.
Reauthorization Required: No
Duration of Reauthorization: N/A
Drug Policy Based On: Payer Specific
Diagnosis Types: 1 of Bone metastases from solid tumors;Hypercalcemia defined as albumin-corrected serum Calcium >12.5mg/dl;Hypercalcemia of malignancy refractory to bisphosphonate therapy;Patients with Multiple Myeloma;Unresectable Giant cell tumor of the bone
Supporting Documentation Must Be Submitted: No
- Prior Authorization: Bone Loss Treatments:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 year(s)
- 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;
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