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Prolia — Highmark

osteoporosis

Preferred products

  • Prolia

Initial criteria

  • The member has osteoporosis or osteopenia or glucocorticoid-induced osteoporosis.
  • The member’s 10-year risk of hip fracture is ≥ 3% using the FRAX calculator.
  • The member is 40 years of age or older AND has a history of glucocorticoid use at a dose of 5 mg per day or more of prednisone (or equivalent) for at least 3 months.
  • The member has experienced therapeutic failure or intolerance to one bisphosphonate OR all bisphosphonates are contraindicated.
  • The member is not receiving Prolia in combination with other parathyroid hormone analogs, RANKL inhibitors, or sclerostin inhibitors.
  • If the request is for Conexxence, Jubbonti, or Stoboclo, the member has experienced therapeutic failure or intolerance to plan-preferred Prolia.

Approval duration

12 months