Subject: Specialty Quantity Limit cinacalcet-Sensipar 1625-H P2022
|
SENSIPAR
(cinacalcet)
|
|
cinacalcet
|
Policy:
I. PROGRAM DESCRIPTION
The standard limit is designed to allow a quantity sufficient for the most
common uses of the medication. The recommended dosing parameters
for the treatment of all FDA-approved indications fall within the standard
limits. Coverage of an additional quantity may be reviewed on a case-
by-case basis upon request.
II. COVERED QUANTITIES
|
Medication
|
Standard Limit*
|
FDA-recommended dosing
|
|
Sensipar (cinacalcet) 30mg tablets
|
60 per 30 days
|
Secondary Hyperparathyroidism:
30, 60, 90, 120, and 180 mg once daily
Parathyroid Carcinoma and Primary Hyperparathyroidism: 30 mg twice daily, 60 mg twice daily, 90 mg twice daily, and 90 mg 3 or 4 times daily
|
|
Sensipar (cinacalcet) 60
mg tablets
|
60 per 30 days
|
|
Sensipar (cinacalcet) 90
mg tablets
|
120 per 30 days
|
*The limits may apply to the generic equivalent medication.
Place of Service:
Outpatient
The above policy is based on the following references:
- Sensipar [package insert]. Thousand Oaks, CA: Amgen, Inc.; December 2019.
- Cinacalcet [package insert]. Cranbury, NJ: Sun Pharmaceuticals Industries, Inc.; June 2020.
Copyright Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
April 17, 2022
