Zoledronic Acid

Aetna covers zoledronic acid 5 mg IV (Reclast) for postmenopausal osteoporosis (treatment or prevention), osteoporosis in men, glucocorticoid‑induced osteoporosis, and Paget’s disease when specified criteria are met, and considers all other indications—and concurrent use of zoledronic 4 mg with other zoledronic formulations or bisphosphonates—experimental/investigational. Coverage requires meeting selection criteria: postmenopausal patients need a fragility fracture OR pre‑treatment T‑score ≤ −2.5 OR osteopenia (T‑score between −2.5 and −1); men and glucocorticoid‑induced osteoporosis require the same except osteopenia is covered only with high pre‑treatment FRAX (glucocorticoid patients must be on ≥2.5 mg prednisone equivalent for ≥3 months); treatment is contraindicated with CrCl <35 mL/min, acute renal impairment or hypocalcemia, and dosing follows Reclast guidance (5 mg IV yearly for treatment, every 2 years for prevention in postmenopausal women; single 5 mg for Paget’s).