The majority of commercial and Medicare plans cover Prolia®. The list price for Prolia® is $1,624.54†,‡ per injection every six months. Most patients do not pay the list price. Your actual cost will vary. Talk to your insurance provider.
The guide below will help you find the insurance coverage most like yours.
Prolia® is an injection administered by a healthcare professional and is covered by both Medicare Part B and Medicare Part D
What you pay will depend on your Medicare plan and whether your doctor orders Prolia® from a distributor (medical benefit) or gets it from a pharmacy (pharmacy benefit).
Ask your doctor how you can get Prolia®
If you are a Medicare Part B patient
of Medicare Part B patients have access to Prolia® as initial therapy*,†
Most Medicare Part B patients have additional insurance and could pay $0 per syringe of Prolia after meeting deductible‡,§
What you pay for Prolia® will depend on the type of Medicare plan you have. Talk to your insurance provider to find out what you will pay for Prolia®.
*All Medical Lives associated with Medicare FFS, Medicare Advantage, and Commercial Coverage Restriction for Prolia® in DRG Coverage snapshot as of 6/2021 included in this analysis.
†First Coast Service Options-Jurisdiction N (MAC B) requires a prior authorization and step edit.
‡Analysis includes Amgen Assist® insurance verification data for Prolia® prospective patients only from 11/2021 to 08/2022.
§The co-pay may depend on coverage of additional insurance plan.
If you are a Medicare Advantage (Medicare Part C) patient
Medicare Advantage is another way to get Medicare services and is offered by private health insurance companies.
If you are a Medicare Part D patient
Some Medicare Part D plans have a preferred specialty pharmacy for filling prescriptions
|MEDICAL AND/OR PRESCRIPTION PLAN||PREFERRED SPECIALTY PHARMACY|
|Express Scripts||Accredo Health Group|
|Cigna||Accredo Health Group|
|CVS Caremark||CVS Specialty|
|Highmark||Accredo Health Group|
|Humana||CenterWell Specialty Pharmacy|
The pharmacies listed above are for information purposes only and may not be comprehensive of all available mandated specialty pharmacies for a particular plan. The information provided is not a guarantee of fulfillment. Information as of 01/20/2023. For the most up-to-date and complete information, please refer to a patient’s health plan regarding specific policies, instructions, and requirements.
If you have a limited income: Medicare beneficiaries may qualify for Extra Help, a program to help pay for medication costs through Medicare Part D. Visit the Medicare website to learn more about Extra Help.
Dual eligibility: Medicare Part D is the primary source of drug coverage for “dual eligible” beneficiaries covered under both Medicare and Medicaid.
The Amgen® SupportPlus Co-Pay Program can help eligible commercially insured patients lower their out-of-pocket prescription costs, including deductible, co-insurance, and co-payment.*
Please see Important Safety Information below.
Direct Enrollment or Through your doctor’s office
With participating pharmacies
*A healthcare representative, including pharmacists, may not enroll you in the Co-Pay Card Program. However, they may assist you if you are commercially insured with enrollment. You will need to be physically present, or on the phone during the enrollment to (1) answer the eligibility questions; (2) indicate that you read, understood, and accepted the Terms and Conditions; and (3) indicate that you read and agreed to the Patient Authorization.
†An itemized EOB is an explanation of benefits from a health plan that typically indicates the amount of insurance coverage for each service and/or treatment at the doctor’s office, as well as the patient’s normal out-of-pocket costs.
Amgen Safety Net Foundation (ASNF) is an independent, nonprofit patient assistance program that provides Prolia® at no cost to qualifying patients who have a financial need and who are uninsured.
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What are the possible side effects of Prolia®?
It is not known if the use of Prolia® over a long period of time may cause slow healing of broken bones. The most common side effects of Prolia® in women being treated for osteoporosis after menopause are back pain, pain in your arms and legs, high cholesterol, muscle pain, and bladder infection.
The most common side effects of Prolia® in men with osteoporosis are back pain, joint pain, and common cold (runny nose or sore throat).
The most common side effects of Prolia® in patients with corticosteroid-induced osteoporosis are back pain, high blood pressure, lung infection (bronchitis), and headache.
The most common side effects of Prolia® in patients receiving certain treatments for prostate or breast cancer are joint pain, back pain, pain in your arms and legs, and muscle pain. Additionally, in Prolia®-treated men with nonmetastatic prostate cancer receiving ADT, a greater incidence of cataracts was observed.
These are not all the possible side effects of Prolia®. Call your doctor for medical advice about side effects.
Prolia® is a prescription medicine used to treat osteoporosis in women after menopause who are at high risk for fracture or cannot use another osteoporosis medicine or other osteoporosis medicines did not work well.
Prolia® is a prescription medicine used to increase bone mass in men with osteoporosis who are at high risk for fracture.
Prolia® is a prescription medicine used to treat osteoporosis in men and women who will be taking corticosteroid medicines (such as prednisone) for at least six months and are at high risk for fracture.
Prolia® is a prescription medicine used to treat bone loss in men who are at high risk for fracture receiving certain treatments for prostate cancer that has not spread to other parts of the body.
Prolia® is a prescription medicine used to treat bone loss in women who are at high risk for fracture receiving certain treatments for breast cancer that has not spread to other parts of the body.