Is zoledronic acid covered by insurance?
Zoledronic acid - *Injection is covered for the treatment of moderate to severe Paget’s disease of bone in men and women: This contractor will cover zoledronic acid once per year for these patients because, after a single treatment, an extended period of remission is observed.
What is the HCPCS code for zoledronic acid?
HCPCS Code Description J3489 Injection, zoledronic acid, 1 mg PURPOSE The Medicare Advantage Policy Guideline documents are generally used to support UnitedHealthcare Medicare Advantage claims processing activities and facilitate providers’ submission of accurate claims for the specified services.
Does Medicare pay for osteoporosis medications?
Medicare Part A or Medicare Part B will pay for a portion of the cost of osteoporosis medications delivered intravenously or by injection. These medications may include ibandronate (Boniva), zoledronic acid (Reclast), denosumab (Prolia) and sometimes calcitonin (Miacalcin).
What is zoledronic acid used for?
Zoledronic acid binds to the bone matrix, which decreases osteoclastic activity, prevents bone resorption and skeletal calcium release induced by various stimulatory factors released by tumors. Zoledronic acid is currently available under the brand names Zometa and Reclast.
How often do you get zoledronic acid infusion?
Zoledronic acid is given by a drip (infusion) into the vein. You have it through a fine tube called a cannula. You usually have it in the outpatient department at the hospital. The infusion takes at least 15 minutes and is usually given once every 3 to 4 weeks.
Does Medicare cover the cost of Reclast?
Reclast is usually not covered for Medicare-eligible patients under Medicare Part D and Medicare Advantage prescription drug plans. However, it may be covered under Medicare Part B as a medical benefit.
How often is zoledronic given?
When zoledronic acid injection is used to treat bone damage caused by multiple myeloma or cancer that has spread to the bones, it is usually given once every 3 to 4 weeks.
Is Reclast IV covered by Medicare?
Do Medicare prescription drug plans cover Reclast? No. In general, Medicare prescription drug plans (Part D) do not cover this drug.
Does Medicare pay for zoledronic acid?
Medicare Part A or Medicare Part B will pay for a portion of the cost of osteoporosis medications delivered intravenously or by injection. These medications may include ibandronate (Boniva), zoledronic acid (Reclast), denosumab (Prolia) and sometimes calcitonin (Miacalcin).
How much does a zoledronic acid infusion cost?
Based on CMS reimbursement data, the average cost of zoledronic acid — including IV administration — is $140 per dose and $74 for administration. Subcutaneous denosumab costs $1,828 per dose and $78 for administration.
Why is zoledronic acid given once a year?
The results of this trial indicate that a once-yearly infusion of zoledronic acid during a 3-year period significantly reduces the risk of vertebral, hip, and other fractures in patients with postmenopausal osteoporosis.
How long does zoledronic acid stay in the bones?
Zoledronic acid medication is a long-acting drug. As such, it stays in your body longer than 12 months (probably more than 24 months). Therefore, delaying your treatment for a number of months will not put you at a higher risk of sustaining fragility fracture nor cause significant decline in your bone mineral density.
What happens when you stop taking zoledronic acid?
The optimal duration of use of zoledronic acid has not been determined. Discontinuation of therapy should be considered by doctors after 3 to 5 years in patients with osteoporosis at low risk of fracture. Patients who discontinue therapy should have their risk for fracture re-evaluated periodically.
What osteoporosis drugs are covered by Medicare?
Original Medicare typically covers osteoporosis injectable drugs like Prolia and a home health nurse visit to inject the drug if you meet certain eligibility requirements:You must be a woman.You must be eligible for Medicare Part B and have paid your premium.More items...•
Which is better Fosamax or Reclast?
Fosamax (alendronate) is a first-choice treatment for osteoporosis, but taking it can be a hassle. Prevents bone loss. Reclast (zoledronate) is a good choice for osteoporosis if you aren't able to take bisphosphonates by mouth. It is available as a generic, but you have to see a doctor to get each dose.
How often will Medicare pay for Prolia injections?
The majority of commercial and Medicare plans cover Prolia®. The list price for Prolia® is $1,434.14* ,† per treatment every six months. Most patients do not pay the list price. Your actual cost will vary.
What percentage of Medicare beneficiaries are MA-PDs?
Most Medicare Advantage beneficiaries ( 88 percent) are enrolled in MA-PDs. 2. Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered. Drug coverage may vary based on plan availability.
How often is reclast given?
Reclast is a prescription medication that contains the active ingredient Zoledronic Acid. It is given IV once every 1 to 2 years for the prevention and treatment of osteoporosis and Paget’s disease treatment. Reclast is a bisphosphonate medication that inhibits bone breakdown to reduce bone loss and risk of fracture.
How to compare Medicare Part D plans?
Compare Plans. Or call. 1-800-557-6059. 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent. You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.
Can I take prescription medications with Medicare?
Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor. Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.
Does Medicare cover reclast?
Because Medicare Advantage plans and Medicare Part D plans do not typically cover Reclast, you will likely be responsible for all costs for this drug if you have one of these types of Medicare coverage.
Does reclast cause dizziness?
Reclast is a bisphosphonate medication that inhibits bone breakdown to reduce bone loss and risk of fracture. The most common side effects of Reclast include nausea and vomiting, dizziness, feeling tired or weak, stomach pain, heartburn, headache, flu-like symptoms, diarrhea, constipation, bone and joint pain and pain in arms or legs.
Document Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act section 1833 (e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Title XVIII of the Social Security Act section 1862 (a) (1) (A).
Coverage Guidance
Note: Etidronate disodium IV has been removed from this policy because it is no longer available in the United States.
How much does zoledronic acid cost?
The cost for zoledronic acid intravenous solution (4 mg/5 mL) is around $41 for a supply of 5 milliliters, depending on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.
What is zoledronic acid used for?
Zoledronic acid is a member of the bisphosphonates drug class and is commonly used for Hypercalcemia of Malignancy, Osteolytic Bone Lesions of Multiple Myeloma, Osteolytic Bone Metastases of Solid Tumors, and others .
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