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: Zoledronic acid 5 mg for IV infusion

Infusion of zoledronic acid 5 mg is not offered at Calgary hospitals, urgent care clinics or the Dr. David Hanley Osteoporosis Centre. Two options for arranging the infusion are outlined below.  This requires a two step process for most patients: Note that each manufacturer - both brand name and generic has their own infusion program and the costs of the infusion are included in the cost of the drug.

PROCESS for IV zoledronic booking

  1.  Alberta Seniors Blue Cross, non-group Blue Cross, AISH require special authorization. See below for coverage criteria and link to form.  Other insurers may require specific forms to be completed.
  2. Prescription "zoledronic acid 5 mg for intravenous infusion" given to patient.  The prescription can be filled at any pharmacy.  The patient will need to take the dispensed medication to the infusion appointment.
  3. The patient can self-enroll into an infusion program (see details below).  An enrollment form will then be sent to the prescriber for approval.  Once the enrollment form is signed by the prescriber, the patient can call the program directly to book an infusion.  Alternatively, the prescriber can complete and submit the enrollment form.  Enrollment forms can be obtained by calling the infusion program.

    For generic brands "Dr. Reddys" and "Taro", phone Infuze at 1-877-767-2260 (patient/prescriber line)

    For innovator brand Aclasta®, phone "For My Bones" at 1-877-580-5338 (patient/prescriber line) 

**Alberta Blue Cross Special Authorization Criteria**   updated May 1, 2018

 "For the treatment of osteoporosis in patients 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:

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

OR

Who have demonstrated persistent severe gastrointestinal intolerance to a course of therapy with either alendronate or risedronate

OR

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).

NOTE

The fracture risk can be determined by the World Health Organization's fracture risk assessment tool, FRAX, or the most recent (2010) version of the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) table.

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 above.  
  • Enrolment must be completed each time when Zoledronic Acid is prescribed. 

Denosumab

Alberta Blue Cross Special authorization criteria:

SPECIAL AUTHORIZATION 

"For the treatment of osteoporosis in patients who have a high 10-year risk (i.e., greater than 20%) of experiencing a major osteoporotic fracture OR a moderate 10-year 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 persistent gastrointestinal intolerance to a course of therapy with either alendronate or risedronate. 

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).

Note: the fracture risk can be determined by the  World Health Organization's fracture risk assessment tool, FRAX, or the most recent (2010) version of the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) table.

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

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.

 

Romosozumab -- Evenity

Romosozumab (Evenity) is a new bone anabolic therapy approved for the prevention of fractures in postmenopausal women at high risk of fractures or who are unable to take one of the other options.  It is a biological therapy - human monocolonal antibody - that bind and inhibits sclerostin, a protein that normally inhibits new bone formation.  

Romosozumab is given as 2 injections of 105 mg (given at the same time for a total dose of 210 mg), subcutaneously, once a month for 12 months and usually followed with anti-resorptive treatment such as bisphosphonate at the end of the 12 month therapy.  Injections may be given by the pharmacist or other licensed health care provided; some patients may prefe to give their own injections and injection training is available through the patient assistance program.  At present, romosozumab is not covered by Alberta's Seniors Blue Cross Program.