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. Options for arranging the infusion are outlined below. Note that the costs of the infusion are included in the cost of the drug for generic products; brand name Aclasta no longer has an infusion program and so patients may be charged an additional infusion fee upon accessing one of the programs below.
PROCESS for IV zoledronic booking
- 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.
- Choose an infusion program, details below.
Generic brand (Zoledronic Acid)
Bayshore Specialty Rx, Phone: 1-877-289-3997, Fax: 1-877-261-5196
Fax prescription with patient’s contact information. Bayshore will contact patient and set up the infusion appointment. The location of infusion clinic will be determined with patient according to home address and preference.
SRx Specialty Health Clinic (Calgary ONLY) Phone: 403-367-1771, Fax: 403-286-0018
Fax prescription with patient’s contact information. SRx will contact patient and set up the infusion appointment. The location of infusion clinic will be determined with patient according to home address and preference.
Infuze program - Phone: 1-877-767-2260, Fax: 1-877-905-6146 https://www.drreddys.com/canada/patient-care-program/
Enrollment must be completed each time Zoledronic Acid is prescribed. Patient or prescriber can call Infuze to enrol. Prescription will be filled at local pharmacy.
For patients living outside of Calgary:
Location
Program(s) offering infusion services
Airdrie
Infuze
Barrhead
Infuze
Canmore
Infuze
Fort McMurray
Infuze
Grand Prairie
Bayshore
Lloydminister
Infuze
Medicine Hat
Bayshore, Infuze
Red Deer
Bayshore, Infuze
**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/DBL/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). Brand name Aclasta no longer includes infusion with the prescription price.
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/DBL/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
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.