Bisphosphonate Drug Therapy
L34648
Intravenous bisphosphonates (ibandronate, pamidronate, zoledronic acid) are covered for a range of bone disorders including osteoporosis in adults >=50 with qualifying T-scores or fragility fractures, osteopenia with high FRAX risk, malignancy-associated hypercalcemia, bone metastases, multiple myeloma, Paget's disease, CTIBL, osteogenesis imperfecta, denosumab discontinuation, and glucocorticoid-induced bone loss. Use of IV therapy in place of oral bisphosphonates requires documentation of oral intolerance, contraindication, malabsorption, compliance/dosing posture issues, or failure of adequate oral trials; specific documentation (BMD/FRAX, labs such as alkaline phosphatase, glucocorticoid duration, GFR) is required. Zoledronic acid for Paget's disease is limited to once per year with re-treatment criteria specified for relapse.
"Postmenopausal women and men age >=50 with a hip or vertebral (including fragility) fracture are eligible for IV bisphosphonate therapy."