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.