4.3 Off-label use of zoledronic
acid (Zometa®) for the treatment of breast cancer may be cost-shared
when:
4.3.1 Patient was premenopausal at the time of diagnosis,
and has stage I or II breast cancer;
4.3.2 Patient has had surgically
induced menopause (e.g., oophorectomy) or has been put temporarily
into menopause (chemically induced menopause with Goserelin or similar
product) prior to administration of zoledronic acid;
4.3.3 Patient
has hormone receptor (Estrogen Receptor (ER) and/or Progesterone
Receptor (PR)) positive disease and zoledronic acid is being used
in combination with hormonal therapy (e.g., Tamoxifen, Arimedex®,
Aromasin®, Femara®);
4.3.4 No concurrent adjuvant chemotherapy
has been given or planned;
4.3.5 Prescriber is an oncologist
or an individual highly familiar with prescribing and monitoring of
oncology-related medications.
4.3.6 Off-label use of omalizumab
(Xolair®) for the treatment of chronic urticaria may be cost-shared.