Reclast (zoledronic acid)
Billing
Code: J3489
Description: Zoledronic acid 1mg
Unit: 1 mg
Payment: $11.141
Pay quarter: Q1 2023
Dosage and Frequency
• 5mg IV every 1 year
Calculate drug reimbursement
Total Reimbursement:
$59.05(ASP: $55.71, Margin: $3.34)
Code:
J3489# Units to bill:
5Prior Authorization
Prior auth criteria for Reclast may include but is not limited to:
1. The patient is 18 years of age or older.
2. The patient has been diagnosed with osteoporosis.
3. The patient has had a DXA scan showing a T-score of -2.5 or lower at the lumbar spine or total hip.
4. The patient has failed or is intolerant to other approved osteoporosis medications.
5. The patient has not had a bisphosphonate infusion in the last two years.
6. The patient has not had a major medical event in the last 6 months.
7. The patient has not had any other treatments for osteoporosis in the last 6 months.
8. The patient has no active infection or history of infection.
9. The patient is not pregnant or breastfeeding.
10. The patient is not at high risk for developing necrosis of the jaw or other serious side effects.
Insurance prior auth guidelines:
Billable NDCs
00078-0435-61
Reclast (NOVARTIS PHARMACEUTICALS CORPORATION)
5 MG
00409-4215-01
ZOLEDRONIC ACID (PFIZER INC.)
4 MG
00409-4215-05
ZOLEDRONIC ACID (PFIZER INC.)
4 MG
00409-4228-01
ZOLEDRONIC ACID (PFIZER INC.)
5 MG
00409-4229-01
ZOLEDRONIC ACID (PFIZER INC.)
4 MG
16714-0815-01
ZOLEDRONIC ACID (NORTHSTAR RX LLC)
4 MG
16729-0242-31
ZOLEDRONIC ACID (ACCORD HEALTHCARE INC.)
4 MG
25021-0801-66
ZOLEDRONIC ACID (SAGENT PHARMACEUTICALS INC)
4 mg
25021-0826-67
ZOLEDRONIC ACID (SAGENT PHARMACEUTICALS INC)
4 MG
25021-0826-82
ZOLEDRONIC ACID (SAGENT PHARMACEUTICALS INC)
4 MG
25021-0830-82
ZOLEDRONIC ACID (SAGENT PHARMACEUTICALS INC)
5 MG
43598-0331-11
ZOLEDRONIC ACID (DR. REDDY'S LABORATORIES, INC.)
5 MG
50742-0416-05
ZOLEDRONIC ACID (INGENUS PHARMACEUTICALS, LLC)
4 MG
51991-0064-98
ZOLEDRONIC ACID (BRECKENRIDGE PHARMACEUTICAL)
5 MG
51991-0065-98
ZOLEDRONIC ACID (BRECKENRIDGE PHARMACEUTICAL)
4 MG
55111-0685-07
ZOLEDRONIC ACID (DR. REDDY'S LABORATORIES, INC.)
4 mg
55111-0688-52
ZOLEDRONIC ACID (DR. REDDY'S LABORATORIES, INC.)
5 MG
63323-0961-98
ZOLEDRONIC ACID (FRESENIUS KABI)
4 MG
63323-0966-00
ZOLEDRONIC ACID (FRESENIUS KABI)
5 MG
67457-0390-54
ZOLEDRONIC ACID (MYLAN INSTITUTIONAL LLC)
4 MG
67457-0619-10
ZOLEDRONIC ACID (MYLAN INSTITUTIONAL LLC)
5 MG
67457-0794-10
ZOLEDRONIC ACID (MYLAN INSTITUTIONAL LLC)
5 MG
67457-0920-05
ZOLEDRONIC ACID (MYLAN INSTITUTIONAL LLC)
4 MG
68001-0366-25
ZOLEDRONIC ACID (AMERICAN HEALTH PACKAGING)
4 MG
70860-0210-51
ZOLEDRONIC ACID (ATHENEX)
4 MG
70860-0802-82
ZOLEDRONIC ACID (ATHENEX)
5 MG
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