Does Medicare Cover Zoledronic Acid?

Certain health conditions and various medical treatments may cause a person to experience bone loss. To help with this issue and avert added injury, some people may take medication containing zoledronic acid. The substance is also known as zoledronate and sold as the brand name products, Zometa or Reclast. All of these medications may help to stop the weakening of bones or hinder density loss. 

Medicare Benefits Solutions

Feb 28, 2021

 4 minutes read

Some common conditions that physicians may prescribe zoledronic acid for include:

  • Paget’s disease of bone (PDB) is an illness that affects bones in a way that makes them brittle, or PDB may bring about malformation of the bones when the condition doesn’t receive adequate treatment.
  • Some kinds of cancer can give rise to hypercalcemia, which is when there is a high concentration of calcium in the blood and could partly be responsible for bone fragility. Bones can also collapse because of bone marrow cancer or bone cancer. 
  • Osteoporosis, which could result from steroid use, gonadal failure or menopause, is a significant contributor to any people’s bones becoming likely to shatter and multiplying the chances of bone fracture.

Different kinds of zoledronic acid have, more or less, greater efficacy for certain bone-related conditions over other types. A person should not take more than one form of the medicine at the same time. Zoledronic acid is not known to be curative of any illnesses, but it has proven its indicative capacity for decelerating symptoms of conditions affecting bone matter. 

Understanding the associated risks and side effects of treatment with zoledronic acid

Zoledronic acid is an intravenous injectable medication. It is common for patients to experience soreness or discomfort at the injection site. Some side effects reported are flu-like symptoms like fatigue or fever after receiving the initial infusion. Patients don’t report having those symptoms with the injections that follow. People also say they experience other side effects of moderate or mild severity, such as limb-swelling or anemia. 

Experts recommend that before getting an injection, a person hydrates him or herself sufficiently, as doing so could assist in impeding substantial dangers that could lead to kidney impairment. Your medical provider will likely want to monitor your blood before and after injections to avoid the precariousness associated with being deficient of vitamin D and calcium levels. 

There is a scarce but grievous likelihood of other issues occurring for some patients with a history of dental extractions or cancer treatment. If your medical doctor intends to prescribe you zoledronic acid injections, make sure you’ve been wholly informative about your medical past, especially any dental work or cancer medicaments. 

Zoledronic acid and Medicare coverage

When attempting to figure out if a particular medication has Medicare coverage, insurance beneficiaries can give thought to a few different scenarios. When it comes to Medicare benefits’ drug coverage, the majority of the time, prescription medications have indemnification under a Part D prescription drug plan, or a Medicare Advantage plan that includes drug insurance. Suppose a recipient doesn’t have either of the two programs. A provider can consider certain medications administered in hospital or outpatient settings to be medically necessary as a curative means to make a patient’s qualifying condition better. In that case, Medicare could pay for the medications as an exception. 

Medicare Part B coverage may pay a portion of your care and drug expenses if your physician prescribes zoledronic acid as an outpatient treatment. Your Medicare benefits will not absolve you from having to make a copayment or paying a coinsurance amount if applicable, including a deductible amount. Coverage terms for Medicare Part A may provide zoledronic acid benefits if your doctor administers the injections upon your entrance into a skilled nursing facility or with admittance into a hospital. 

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