Reclast® Medicare Coverage

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.

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.

How much does Reclast cost with Medicare?

If Medicare Part B covers Reclast treatments for you because you meet the qualifying conditions, you’ll typically pay 0% to 20% of the Medicare-approved amount for the Reclast prescription price, after you meet your Part B deductible.

In 2024, the Medicare Part B deductible is $240 per year. Once you pay this amount, you’ll pay the remaining copay costs Medicare Part B doesn’t cover.

Does Medicare cover Reclast?

Medicare Part B covers injectable osteoporosis drugs like Reclast if you meet all of the following conditions:

• You are a woman who has osteoporosis.
• You qualify for Medicare home health care benefits.
• A doctor confirms you have a bone fracture related to post-menopausal osteoporosis.
• Your doctor certifies you need help administering the injection and can’t give it to yourself.

If your family members or caregivers aren’t able to give you the injection, Medicare covers a home health nurse or aide to provide the injection in your home.

You don’t need a Medicare Advantage plan or a Medicare Part D prescription drug plan to get Reclast coverage.¹

If you have either type of private drug plan, you’re enrolled in Medicare Part B, and you qualify for Medicare coverage of Reclast, your Part B benefits will cover Reclast.

Some Medicare Advantage plans and Medicare Part D plans cover other prescription drugs that aren’t administered in a doctor’s office or by a medical professional.

• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.²
• Part D or Medicare Advantage plans that cover prescription drugs include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• 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. You may be able to find Medicare Advantage plan options in your area that cover prescription drugs. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

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.

Additional information

Reclast should be administered by a licensed healthcare provider in a healthcare facility. Your doctor may recommend calcium and Vitamin D to support your bone health.

You may not be able to use Reclast if you have severe kidney problems. Jaw bone problems may occur after receiving this medication.

Your risk for jaw bone problems may be higher if you have cancer, dental problems, dentures that do not fit well, anemia, blood clotting problems or an infection.

Call your doctor right away if you have unusual jaw pain or swelling. Practice good dental hygiene and get regular check-ups to prevent any problems.

Reclast may cause fertility problems and can cause harm to an unborn baby if you are pregnant. If you are able to get pregnant, a pregnancy test will be done prior to receiving Reclast to ensure you are not pregnant.

Use birth control to prevent pregnancy during treatment with this drug and after your last dose. If you get pregnant while taking this drug or within several months after the last dose, call your doctor right away.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. 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.

Written by Hayden Gharibyar, Pharm.D.