Prolia® is an injection administered by a healthcare professional and is covered by bothMedicare 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®
Nearly 77% of Medicare Part B Prolia® patients have supplemental insurance‡ and pay $0§ out-of-pocket every six months
The remaining 23% of Medicare Part B Prolia® patients pay up to $212.99§,** out-of-pocket every six months depending on the patient's selected Part B plan
Patients pay for Prolia® twice per year
These data do not include out-of-pocket costs related to office visits or administration of Prolia®
63% of all Medicare Part D patients pay less than $50§,** out-of-pocket every six months
36% of all Medicare Part D patients pay $50.02-$667.29§,** out-of-pocket every six months††
Your out-of-pocket costs can vary throughout the year depending on which phase‡‡ of the Part D benefit you are currently in
If you are eligible for the Extra Help§§ program, you pay as little as $3.70 out-of-pocket every six months
Patients pay for Prolia® twice per year
These data do not include out-of-pocket costs related to office visits or administration of Prolia®
‡Supplemental insurance, also known as secondary insurance or Medigap, helps cover the remaining 20% of therapies that are provided through Medicare Part B. Medicare patients with supplemental coverage may require additional monthly premium. Individual out-of-pocket costs will vary.
§This data is based on Medicare claims between 10/2017 - 06/2018 and only applies to your cost for Prolia®.
**Patients on high deductible plans may pay more out-of-pocket for Prolia®.
††The remaining 1% will pay more out-of-pocket.
‡‡Medicare Part D drug coverage is divided into four phases, each with a different cost sharing amount. Those phases are 1) Deductible, 2) Initial coverage, 3) Coverage gap, 4) Catastrophic.
§§ Additional assistance with Medicare Prescription Drug Plan Costs from the Social Security Administration (SSA) https://www.ssa.gov/benefits/medicare/prescriptionhelp. Accessed on March 22, 2019.
59% of commercial prescriptions cost $50 or less per six months, the remaining 41% of commercial prescriptions cost an average of $437 per six months. ***
Your out-of-pocket costs may vary depending on your insurance plan. Each plan has different out-of-pocket costs, and most include an annual deductible. Patients on high deductible plans may pay more out-of-pocket for Prolia®.
And eligible commercial patients could pay $25 or less with the Prolia® Co-Pay Program for 1 shot of Prolia® up to the program maximum of $1,500 per calendar year.†††
***Based on paid claims data from national data providers for the period 1/1/2018 - 12/31/2018. These data do not include out-of-pocket costs related to office visits or administration of Prolia®. Your actual cost may vary depending on your insurance coverage and eligibility for and participation in support programs such as the Prolia® co-pay program. Talk to your insurance provider for specific information about your prescription coverage.
†††This program does not provide support for any physician-related services associated with administration of Prolia®. See eligibility and limits.
For more information about this program and eligibility requirements, call 844-369-9962 or visit proliasupport.com.
The Prolia® Co-pay Program Prepaid MasterCard® is issued by Comerica Bank pursuant to license by MasterCard International Incorporated. No cash or ATM access. MasterCard is a registered trademark of MasterCard International Incorporated. This card can be used only to cover co-payment for eligible prescriptions covered under the program at participating merchant locations where Debit MasterCard is accepted.
