Evenity — Highmark

osteopenia

Initial criteria

The member is a postmenopausal female.
The member is at high or very high risk for a fracture as defined by one of the following: history of previous hip fracture (ICD-10: M84.359) or vertebral fracture (ICD-10: S22.0); diagnosis of osteoporosis (ICD-10: M80-81) defined as a T-score ≤ -2.5; diagnosis of osteopenia (T-score between -1.0 and -2.5) with 10-year risk of major osteoporotic fracture ≥ 20% using FRAX calculator; or 10-year risk of hip fracture ≥ 3% using FRAX calculator.
The member meets one of the following: has experienced therapeutic failure or intolerance to one bisphosphonate OR all bisphosphonates are contraindicated; OR is at very high risk for a fracture defined as having multiple spine fractures AND a T-score ≤ -2.5.
The member has not exceeded the lifetime limit of 12 monthly doses.
The member is not receiving Evenity in combination with other parathyroid hormone analogs, RANKL inhibitors, or sclerostin inhibitors.

12 months