Subject: Specialty Quantity Limit cinacalcet-Sensipar 1625-H P2023

Drug

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) 30 mg tablets	60 tablets per 30 days	Secondary Hyperparathyroidism:   30, 60, 90, 120, or 180 mg once daily     Parathyroid Carcinoma and Primary   Hyperparathyroidism:   30 mg twice daily, 60 mg twice   daily, 90 mg twice daily, or 90 mg 3 or 4 times daily
Sensipar (cinacalcet) 60 mg tablets	60 tablets per 30 days
Sensipar (cinacalcet) 90 mg tablets	120 tablets 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:

1. Sensipar [package insert]. Thousand Oaks, CA: Amgen, Inc.; December 2019.
2. Cinacalcet [package insert]. Cranbury, NJ: Sun Pharmaceuticals Industries, Inc.; December 2021.

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 11, 2024