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Zoledronic Acid (Reclast®)
BCBS Tennessee·TN · Endocrinology, Rheumatology, Oncology +4 more·Medical Policy
Effective date
Jul 31, 2026
We identified it
Jun 17, 2026
Summary
New medical policy for Zoledronic Acid (Reclast®) establishes prior authorization requirements and coverage criteria for osteoporosis treatment, Paget's disease, and prostate cancer bone loss. The policy requires specific documentation including T-scores, FRAX probability assessments, and fracture history for approval.
Action Required
Before July 31, 2026: Billing team must implement prior authorization requirements for Zoledronic Acid (Reclast®). Update systems to capture required documentation: T-scores, FRAX probability assessments, fracture history, and ADT therapy claims history. Train providers on coverage criteria for postmenopausal osteoporosis, male osteoporosis, glucocorticoid-induced osteoporosis, Paget's disease, and prostate cancer indications. Claims without proper prior authorization and documentation will be denied.