Medicare AdvantagePrior AuthMedium impact
Reclast® (zoledronic acid) (Revised)
Humana·Endocrinology, Rheumatology, Orthopedics +2 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised their prior authorization policy for Reclast (zoledronic acid) effective January 1, 2026. The policy requires prior authorization for all Reclast treatments and establishes specific criteria for brand vs generic coverage across four indications: osteoporosis, osteoporosis prophylaxis, glucocorticoid-induced osteoporosis, and Paget's disease.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows for all Reclast (zoledronic acid) requests for Humana Medicare Advantage patients. Providers must document diagnosis, previous treatment history with generic zoledronic acid for brand requests, and evidence of contraindication/intolerance to oral bisphosphonates. Update EMR templates to include required criteria documentation. Claims will require prior authorization approval before administration.