@cliffdweller - I don't know how the insurance companies make their decisions or how the drs propose the need for the bone meds, but here's my experience:

No dr ever, ever pointed out over the yrs that I had osteopenia that eventually moved into the osteoporosis range. An endocrinologist who was seeing me for the first time for thyroid nodules was reviewing my heath chart (same medical group) & asked if anyone had ever addressed my OP scores. Nope! So I made another appt w/her (HMO Medicare ins, so had to go thru my PCP first) to discuss the scores: spine -3.5; hips both -2.8 & recommended meds.

She requested Evenity and there was no push-back or hesitation from the ins company. I even asked to change drs before I started the Evenity course so that the injections could be done at a location closer to my home. Again, no hesitation from the ins company even though I had a new prescribing dr.