Medication Access Information

Access to Osteoporosis Medication

There are many treatment options available but accessing them can be confusing.  This information is provided to assist physicians with up to date reimbursement criteria and applications for the various anti-fracture drugs.  While we make every effort to keep this list up to date, changes to coverage criteria, processes and program enrolment links may occur without notice and you may need to check with the insurer/provider directly if any question.

Oral bisphosphonates

Alendronate 70 mg once weekly, alendronate 70 mg + 5600 Units D3
Risedronate 35 mg once weekly
**regular benefit on Alberta Blue Cross** 

Actonel DR 35 mg once weekly
Actonel 150 mg once monthly
***Not a benefit with Alberta Blue Cross***

Intravenous Bisphosphonates

This requires a three step process for most patients:

  1. Alberta Blue Cross special authorization form (where applicable)
  2. Enrollment in a Zoledronic Acid Infusion Program.  Each manufacturer – both brand name and generic has their own infusion program (costs of infusion included in drug cost), links to the program are given below.
  3. Physician gives prescription to patient to be filled at pharmacy and patient takes the medication to the infusion centre.

**Alberta Blue Cross Special Authorization Criteria**

 "For the treatment of postmenopausal osteoporosis in women who have a high 10-year risk (i.e., greater than 20%) of experiencing a major osteoporotic fracture, as demonstrated by at least two of the following:

  • Age greater than or equal to 75 years
  • A prior fragility fracture
  • A bone mineral density (BMD) T-score of less than or equal to -2.5

AND at least one of the following:

1. For whom oral bisphosphonates are contraindicated due to an abnormality of the esophagus which delays esophageal emptying;

OR

2. Who have demonstrated severe gastrointestinal intolerance to a course of therapy with either alendronate or risedronate. Severe gastrointestinal intolerance is defined as manifested by weight loss or vomiting directly attributable to the oral bisphosphonates.

OR

3. Who had an unsatisfactory response (defined as a fragility fracture despite adhering to oral alendronate or risedronate treatment fully for 1 year and evidence of a decline in BMD below pre-treatment baseline level).

Necessary Links

Link to Alberta Blue Cross Special Authorization form:
https://idbl.ab.bluecross.ca/idbl/PDFS/60007.pdf 

Zoledronic Acid 5mg is available as Aclasta® and generics. Patients who are paying out of pocket for the medication should be advised that the cost of Aclasta® (~$800) is approximately double that of the generic brands (~$400). Each brand provides free infusion services for their products. The patient must utilize the infusion program that corresponds to the brand of Zoledronic Acid that they have been prescribed. For instance, the Aclasta® infusion program will not infuse generic brands and vice versa.

  • Prescription written by physician- Zoledronic Acid 5mg intravenously yearly.  Patient fills prescription at pharmacy and takes the product to the infusion centre (directions provided by the brand program).   Choose a brand of Zoledronic Acid and follow the instructions below.  
  • Enrolment must be completed each time when Zoledronic Acid is prescribed. 

For generic brand Dr. Reddys

  • Enrol in Infuze program. Enrolment forms can be obtained by calling or emailing the program.  Tel: 1-877-767-2260, Fax: 1-877-905-6146, This email address is being protected from spambots. You need JavaScript enabled to view it..  

For generic brand Taro

  • Patient contacts Coverdale Clinics to arrange infusion appointment, Tel: 1-866-210-0399. There is no patient support program available.

For innovator brand Aclasta®

  • Enrol in For My Bones program. Enrolment forms can be obtained by calling the program.  Tel: 1-877-580-5338, Fax: 1-877-580-5325.

Denosumab

Alberta Blue Cross Special authorization criteria:

SPECIAL AUTHORIZATION 

Postmenopausal Osteoporosis:

"For the treatment of postmenopausal osteoporosis in women who have a high 10-year risk (i.e., greater than 20%) of experiencing a major osteoporotic fracture, as demonstrated by at least two of the following:

  • Age greater than or equal to 75 years
  • A prior fragility fracture
  • A bone mineral density (BMD) T-score of less than or equal to -2.5

AND at least one of the following: 

1. For whom oral bisphosphonates are contraindicated due to drug-induced hypersensitivity (i.e., immunologically mediated),

OR

2. For whom oral bisphosphonates are contraindicated due to an abnormality of the esophagus which delays esophageal emptying,

OR

3. For whom bisphosphonates are contraindicated due to severe renal impairment (i.e. creatinine clearance < 35 mL/min),

OR

4. Who have demonstrated severe gastrointestinal intolerance to a course of therapy with either alendronate or risedronate. Severe gastrointestinal intolerance is defined as manifested by weight loss or vomiting directly attributable to the oral bisphosphonates,

OR

5. Who had an unsatisfactory response (defined as a fragility fracture despite adhering to oral alendronate or risedronate treatment fully for 1 year and evidence of a decline in BMD below pre-treatment baseline level).

Links to special authorization form:
https://idbl.ab.bluecross.ca/idbl/PDFS/60007.pdf 

Osteoporosis in Men:

"For the treatment of osteoporosis in men who have:
A high 10-year risk (i.e., greater than 20%) of experiencing a major osteoporotic fracture,
OR
A moderate 10-year fracture risk (10-20%) and have experienced a prior fragility fracture;

AND

at least one of the following:
1) For whom oral bisphosphonates are contraindicated due to drug-induced hypersensitivity (i.e., immunologically mediated),
OR


2) For whom oral bisphosphonates are contraindicated due to an abnormality of the esophagus which delays esophageal emptying,
OR


3) For whom bisphosphonates are contraindicated due to severe renal impairment (i.e. creatinine clearance < 35 mL/min),
OR


4) Who have demonstrated severe gastrointestinal intolerance to a course of therapy with either alendronate or risedronate. Severe gastrointestinal intolerance is defined as manifested by weight loss or vomiting directly attributable to the oral bisphosphonates,
OR


5) Who had an unsatisfactory response (defined as a fragility fracture despite adhering to oral alendronate or risedronate treatment fully for 1 year and evidence of a decline in BMD below pre-treatment baseline level).

Starting a patient on Denosumab (Prolia):

Provital Support Program – this program keeps track of the injections and provides reminder calls.  

Registration is optional.  Enrolment forms are available at www.prolia.ca 

Visit the website for Provital Support Program enrolment form.  Patient can also self-register by calling 1-877-776-1002. 

Subcutaneous injections can be done by family physicians, registered nurses, or community pharmacists. 

Prescription written by physician – Denosumab 60mg subcutaneously every 6 months.

Teriparatide

***Not a benefit with Alberta Blue Cross***

Teriparatide (Forteo®)

Forteo Customer Care (FCC) program – this program oversees the dispensing of Forteo and  provides financial assistance and injection training to patients.

Enrolment form to be completed by physician and patient. Prescription is printed on the form to be sent to FCC. Enrolment forms can be obtained by calling the FCC program, Tel: 1-877-436-7836, Fax: 1-800-999-1123.

FCC contacts patient to discuss insurance coverage and medication dispensing/ delivery.  An in-home nurse visit will be arranged by FCC to provide training on self-injection with Forteo pen. 

Prescription written by physician – Teriparatide 20mcg subcutaneously daily x 24 months.

Raloxifene – Evista

Blue Cross special auth criteria:

For the treatment of osteoporosis in patients with a 20% or greater 10-year fracture risk who have documented intolerance to alendronate 70 mg or risedronate 35 mg.