Reclast policy criteria

[chantell.reagan]

Based on the popularity of our previous analyses, we extended the review of biologic agents to zoledronic acid. Although zoledronic acid is also available as Zometa (for hypercalcemia of malignancy and multiple myeloma and bone metastases from solid tumors), our analysis focused on Reclast which was recently approved for once-yearly infusion for the treatment of postmenopausal osteoporosis (PMO) and Paget’s Disease.

The latest treatment guidelines on the management of osteoporosis issued by the American College of Physicians in 2008 did include Reclast; however, its positioning wasn’t distinguished from oral bisphosphonates. It was noted that in clinical trials, ulcers and bleeding events occurred with all of the bisphosphonates, except zoledronic acid. Two additional relatively recent guidelines issued by ICSI and National Osteoporosis Foundation discussed Reclast in terms of the relative reduction of fracture risk.

Of note, there are no recent national guidelines for Paget’s disease that address Reclast.

Our analysis of Reclast policies issued by 7 plans showed that 6 of 7 plans require failure, intolerance, or contraindication of at least 1 oral bisphosphonate prior to using Reclast in osteoporosis patients, which is somewhat similar to the Veterans Administration (VA) criteria. Interestingly, 2/7 plans did not include Paget’s disease in their policies and only one plan required failure, intolerance, or contraindication of oral bisphosphonate therapy prior to the use of Reclast in patients with Paget’s disease.

Please see the attached document with the table, which compares Reclast policies.

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Sources:

Blue Cross and Blue Shield of Florida. Medical coverage guidelines
Blue Cross Blue Shield of Massachusetts Bisphosphonates policy
Excellus BlueCross BlueShield. Prior authorization list for Medicare Part D
Independence Blue Cross Medical Policy
The Regence Group. Zoledronic acid
Aetna. Clinical Policy Bulletin: Zoledronic acid
Humana Reclast Medical Coverage Policy

Sources: