TYMLOS (abaloparatide) — Blue Cross Blue Shield of Kansas

osteoporosis

Initial criteria

1. ONE of the following: patient has been treated with requested agent within past 90 days OR prescriber states patient treated within past 90 days AND at risk if therapy changed OR patient has diagnosis of osteoporosis AND ALL of the following:
patient is male AND (age ≥ 50 years OR requested agent medically appropriate for patient's age/sex) OR patient is female AND (postmenopausal OR requested agent medically appropriate for sex/menopause status)
diagnosis confirmed by ONE of: fragility fracture in hip or spine OR T-score ≤ -2.5 OR T-score between -1.0 and -2.5 AND ONE of: fragility fracture of proximal humerus, pelvis, or distal forearm OR FRAX major osteoporotic fracture ≥ 20% OR FRAX hip fracture ≥ 3%
AND ONE of: patient at very high fracture risk (recent fracture within 12 months, fractures on therapy, multiple fractures, fractures on skeletal-harm drugs, T-score < -3.0, high falls risk, or very high FRAX probability ≥ 30% major, ≥ 4.5% hip) OR inadequate response/intolerance/contraindication to all bisphosphonates
AND patient will NOT use in combination with bisphosphonate, denosumab (Prolia, Xgeva), romosozumab-aqqg, or another parathyroid hormone analog (teriparatide)
AND patient does NOT have FDA labeled contraindications to requested agent
AND total duration of treatment with FORTEO (teriparatide), Bonsity, Teriparatide, and TYMLOS (abaloparatide) ≤ 2 years lifetime

remainder of 2 years lifetime