- PA Required
- Quantity Limit: 30 day supply per 1 fill(s).
- Available through Specialty Pharmacy;
- Prior Authorization: Osteoporosis: Post Menopausal Women:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 1 year(s)
- Osteoporosis: Post Menopausal Women:
Duration: 1 year(s)
Medical Test Required: Yes
Reauthorization Required: No
Duration of Reauthorization: N/A
History of Fracture Required: Required
BMD T-score at neck, total hip, or lumbar spine: <= -3
Self-Administration Allowed: No
Multiple fractures required: Yes
Documented Diagnosis: Yes
|