Product Details
Zoledronic Acid for Inj. Concentrate
Zoledronic Acid4 mg/5 mL
Solution for Injection
5-mL Pack (Preservative-Free)
DIN/PIN/NPN
02422425
Manufacturer
Dr. Reddy's Laboratories Inc.
Formulary Listing Date
2014-09-25
Unit Price
415.5600
Amount MOH Pays
415.5600
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
M05BA08
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02248296 | Zometa Concentrate | NA | NA |
02401606 | Zoledronic Acid-Z | 415.5600 | 415.5600 |
02472805 | Zoledronic Acid for Injection | 415.5600 | 415.5600 |
02444739 | Zoledronic Acid for Injection | 415.5600 | 415.5600 |
02434458 | Zoledronic Acid for Injection | 415.5600 | 415.5600 |
02407639 | Zoledronic Acid for Injection | 415.5600 | 415.5600 |
02422425 | Zoledronic Acid for Inj. Concentrate | 415.5600 | 415.5600 |
02413701 | Zoledronic Acid for Inj. Concentrate | 415.0000 | 415.0000 |
02415186 | Taro-Zoledronic Acid Concentrate | 415.5600 | 415.5600 |
02482525 | Jamp-Zoledronic Acid | 415.5600 | 415.5600 |
LU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Oncology – Supportive Management | Zoledronic Acid
Zoledronic acid as Zometa Concentrate will only be considered for the treatment of bony metastases in those with hormone refractory prostate cancer as well as other cancers through the Exceptional Access Program (EAP) in those receiving outpatient care who do not meet the criteria of Cancer Care Ontario (CCO). Zometa is considered through CCO for those receiving prostate cancer treatment from a cancer clinic. Duration of Approval: 6 Months For the treatment of bony metastases for patients with hormone refractory prostate cancer as determined by an elevated PSA level, or evidence of progressive bony disease1, despite castrate serum testosterone levels (less than 50 ng/dL). 1Progressive bony disease should be demonstrated by: Requests for patients who have undergone orchidectomy do not need to provide a serum testosterone level. For the prevention of skeletal related events in patients who have not experienced previous skeletal related events2 and who have bony metastases secondary to:
2A skeletal related event is defined as pathologic fracture, spinal cord compression, radiation therapy to bone or surgery to bone. 3Good performance status is defined as patients that are ambulatory, capable of self-care and up and about more than 50 per cent of waking hours. For the treatment of patients with symptoms due to bony metastases secondary to breast cancer or multiple myeloma who have failed or are intolerant to pamidronate.
Duration of Approval: 6 Months Renewals will be considered for patients who are responding to therapy and are still deemed to require treatment. |