Product Details
Prolia (Preservative Free)
Denosumab60 mg/mL
Solution for Injection
Prefilled Syringe
DIN/PIN/NPN
02343541
Manufacturer
Amgen Canada Inc.
Formulary Listing Date
2012-02-29
Unit Price
440.1000
Amount MOH Pays
440.1000
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
M05BX04
Interchangeable Products
NOLU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
Note: In all cases, patients receiving Prolia must not be receiving concomitant bisphosphonate therapy. The recommended dose of PROLIA (denosumab) is a single SC injection of 60 mg, once every 6 months. | ||
690 | 12 months from date of authorization | Only for a patient who is established on Prolia (denosumab) therapy prior to November 29, 2024 and who is or becomes palliative requiring end-of-life care during the biosimilar transition period between November 29, 2024 to August 29, 2025. Patient must also meet the following criteria: - The patient is a postmenopausal female or male with osteoporosis and Prolia (denosumab) is being used to increase the bone mass in the patient; - The patient is at high risk* for fracture; and - One of the following applies to the patient: - The patient has failed other available osteoporosis therapy (i.e., fragility fracture or evidence of a decline in bone mineral density below pre-treatment baseline levels) despite adherence to the therapy for one year; or - bisphosphonates are contraindicated for the patient due to hypersensitivity, abnormalities of the esophagus (e.g., esophageal stricture or achalasia), or inability to stand or sit upright for at least 30 minutes. *High risk of fracture is defined as one of the following: - a prior fragility fracture AND a moderate 10-year fracture risk (10% to 20%) based on the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool or the Fracture Risk Assessment (FRAX) tool; - a high 10-year fracture risk (greater than or equal to 20%) based on the CAROC or FRAX tool; or - where a patient's 10-year fracture risk based on the CAROC or FRAX tool is less than the thresholds defined above, a high fracture risk based on evaluation of clinical risk factors for fracture. Note: Use of the CAROC or FRAX tool may underestimate fracture risk in certain circumstances and may not include all risk factors. Funded duration: One period of up to 12 months beginning on the date of the first prescription with RFU code 690 is dispensed for the patient. |