Anthem Blue Cross (HMO, PPO, EPO)
Zometa (zoledronic acid)
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

  • Available only through Specialty Pharmacy;
  • Prior Authorization: Bone Loss Treatments:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

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