Jubbonti (denosumab-bbdz) — Highmark
nonmetastatic prostate cancer with bone loss
Preferred products
- Prolia (denosumab)
Initial criteria
- FOR males: diagnosis of nonmetastatic prostate cancer (ICD-10: C61) AND T-score ≤ -1.0 AND (multiple risk factors for a fracture OR previous fragility fracture) AND receiving androgen deprivation therapy (ADT) for nonmetastatic prostate cancer AND if the requested agent is Conexxence, Jubbonti, or Stoboclo, there has been therapeutic failure or intolerance to plan-preferred Prolia.
- FOR females: diagnosis of breast cancer (ICD-10: C50, D05) AND T-score ≤ -1.0 AND (multiple risk factors for a fracture OR previous fragility fracture) AND receiving adjuvant aromatase therapy for breast cancer AND if the requested agent is Conexxence, Jubbonti, or Stoboclo, there has been therapeutic failure or intolerance to plan-preferred Prolia.