Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
risedronate 30mg

Criteria Approval Period
Diagnosis of Paget's disease
PLUS
an adequate trial of etidronate that has failed to reduce symptoms and/or has not reduced levels of alkaline phosphatase		 Indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • Adequate trial is defined as at least two months of etidronate therapy.

Online Forms (PDF)
Click on the link to complete a special authority request form.