Wiki Reclast

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vramirez

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Our OB/GYN would like to begin using Reclast on patients that have not been diagnosed with osteoporosis or osteopenia but have a high fracture risk.
I would like something to back this up... anyone have any information you can share with me?
 
vramirez said:
Our OB/GYN would like to begin using Reclast on patients that have not been diagnosed with osteoporosis or osteopenia but have a high fracture risk.
I would like something to back this up... anyone have any information you can share with me?
Click to expand...

It is very difficult to get Reclast authorization even if they have osteoporosis or osteopenia. Most insurance carriers require that the patient has failed all other forms of therapy. Would need to know specific reasoning behind why the doctor wants it for this patient.
 
In most cases, the patients we pursue reclast in have some sort of intolerance to oral biphosphenates, or have tried them and are not improving on their bone density. We rarely recommend it prior to trying some sort of oral biphosphenate first.
 
vramirez said:
In most cases, the patients we pursue reclast in have some sort of intolerance to oral biphosphenates, or have tried them and are not improving on their bone density. We rarely recommend it prior to trying some sort of oral biphosphenate first.
Click to expand...

Right, that is the way most providers do it. From there it just depends on the diagnosis codes for the patient. Most carriers are very specific on the reasons for prescribing Reclast instead of a lesser expensive drug. Each case will be different and you will probably have to pursue them as them arise. My OB/Gyn practice chose not to pursue giving Reclast because of the expense and the difficulty in getting it authorized.
 
vramirez said:
What is dx for fracture risk?
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There is no one diagnosis for fracture risk. It is whatever medical problem the patient has that makes them at a high risk for fractures. Usually it is osteoporosis or osteopenia, but some cancers especially bone cancer can put you at higher risk for fractures. Hypercalcemia can also put you at high risk for fractures. That is why I was saying, you may have trouble getting authorizations for Reclast for high fracture risk.....WHY is the patient at high risk for fracture. Then see if that reason is acceptable to the insurance carrier.
 
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