Prolia® (denosumab) Cost and Copay Information

I am on Medicare

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®

Example of Medicare Health Insurance card

If you are a Medicare Part B patient

93^%

of Medicare Part B patients have access to Prolia® as initial therapy*,^†

No step edit required
No prior authorization required

Most Medicare Part B patients have additional insurance and could pay $0 per syringe of Prolia after meeting deductible^‡,^§

After you meet your deductible, Medicare Part B covers 80% of therapies you receive in your doctor’s office
You can obtain an additional insurance (e.g., Medicare Supplement Plan or Medigap, commercial, TRICARE) to pick up the additional 20%
- You may need to pay additional monthly premiums with these additional insurances.
Out-of-pocket costs do not include costs related to office visits or administration of Prolia®.

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.

Cost and coverage vary by plan so it’s important to verify your insurance benefits and out-of-pocket costs for Prolia®

If you are a Medicare Part D patient

96^%

of Medicare Part D patients*
have access* to Prolia®^†

Pharmacy patients: Some Medicare Part D plans have a preferred specialty pharmacy and some commercial plans require a specific specialty pharmacy for filling your Prolia® prescription.

Preferred Specialty Pharmacies^‡

Some Medicare Part D plans have a preferred specialty pharmacy for filling prescriptions

MEDICAL AND/OR PRESCRIPTION PLAN	PREFERRED SPECIALTY PHARMACY
Aetna	CVS Specialty
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.

Example of Medicare Part D Prescription Drug Plans card

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.

*Access is defined as the ability of a patient to obtain Prolia®, although patient OOP cost and insurance requirements may vary.
^†All Retail Lives associated with Medicare Part D coverage Restriction for Prolia® in DRG Coverage data snapshot as of Q2 2022 are included in this analysis.
^‡The information is provided as a courtesy only and Amgen does not guarantee the accuracy of the information.

To learn more call 1-866-264-2778

I have commercial insurance (e.g. self-purchased or through an employer)
Helping eligible commercially insured patients lower out-of-pocket costs
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.*

For Prolia®, pay as little as $25 out-of-pocket for each dose

Can be applied to deductible, co-insurance, and
co-payment*
*Eligibility criteria and program maximums apply. See www.amgensupportplus.com/copay for full Terms and Conditions.

Help patients enroll online at www.amgensupportplus.com/copay or by phone at 1-866-264-2778

HOW TO GET STARTED
Please see Important Safety Information below.

Options to enroll in and how to use the Amgen SupportPlus Co-Pay Program.

Option 1:

Direct Enrollment or Through your doctor’s office

Your doctor’s office can assist you with enrollment* or you can enroll yourself.

Online: AmgenSupportPlus.com/copay

Phone: (866) 264-2778

The co-pay card details can be accessed via the online portal or by calling (866) 264-2778

Submitting a Claim: You or your doctor’s office can send in the itemized EOB^† to the Amgen SupportPlus Co-Pay Program after each treatment using one of the options below.

Online: Submit a claim by uploading it to your account on AmgenSupportPlus.com/copay

Fax: 844-369-9961

Mail: Amgen SupportPlus Co-Pay Program 100 Passaic Avenue, Suite 245 Fairfield, NJ 07004

Once the claim is approved, the Amgen SupportPlus Co-Pay Card can be used to reduce your out-of-pocket cost

Option 2:

With participating pharmacies

After being prescribed an Amgen product, you can work with participating specialty or retail pharmacies to enroll* in the Amgen SupportPlus Co-Pay Program and also activate a virtual co-pay card.

The specialty pharmacy will process the claim with card information listed here:

Member ID

RxBIN

PCN

Group Number

The pharmacy will help coordinate the shipment of your medication directly to the site of care or to you so that it is available for administration

*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.
I am uninsured

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.
TAKE ME TO AMGEN SAFETY NET FOUNDATION

Important Safety Information

Do not take Prolia® if you: have low blood calcium; or are pregnant or plan to become pregnant, as Prolia® may harm your unborn baby; or are allergic to denosumab or any ingredients in Prolia®.

What is the most important information I should know about Prolia®?

If you receive Prolia®, you should not receive XGEVA®. Prolia® contains the same medicine as XGEVA® (denosumab).

Prolia® can cause serious side effects:

Serious allergic reactions have happened in people who take Prolia®. Call your doctor or go to your nearest emergency room right away if you have any symptoms of a serious allergic reaction, including low blood pressure (hypotension); trouble breathing; throat tightness; swelling of your face, lips, or tongue; rash; itching; or hives.

Low blood calcium (hypocalcemia). Prolia® may lower the calcium levels in your blood. If you have low blood calcium, it may get worse during treatment. Your low blood calcium must be treated before you receive Prolia®.

Take calcium and vitamin D as your doctor tells you to help prevent low blood calcium.

Severe jaw bone problems (osteonecrosis) may occur. Your doctor should examine your mouth before you start Prolia® and may tell you to see your dentist. It is important for you to practice good mouth care during treatment with Prolia®.

Unusual thigh bone fractures. Some people have developed unusual fractures in their thigh bone. Symptoms of a fracture include new or unusual pain in your hip, groin, or thigh.

Increased risk of broken bones, including broken bones in the spine, after stopping, skipping or delaying Prolia®. Talk with your doctor before starting Prolia® treatment. After your treatment with Prolia® is stopped, or if you skip or delay taking a dose, your risk for breaking bones, including bones in your spine, is increased. Your risk for having more than 1 broken bone in your spine is increased if you have already had a broken bone in your spine. Do not stop, skip or delay taking Prolia® without first talking with your doctor. If your Prolia® treatment is stopped, talk to your doctor about other medicine that you can take.

Serious infections in your skin, lower stomach area (abdomen), bladder, or ear may happen. Inflammation of the inner lining of the heart (endocarditis) due to an infection may also happen more often in people who take Prolia®. You may need to go to the hospital for treatment.

Prolia® is a medicine that may affect the ability of your body to fight infections. People who have weakened immune systems or take medicines that affect the immune system may have an increased risk for developing serious infections.

Skin problems such as inflammation of your skin (dermatitis), rash, and eczema have been reported.

Bone, joint, or muscle pain. Some people who take Prolia® develop severe bone, joint, or muscle pain.

Before taking Prolia®, tell your doctor about all of your medical conditions, including if you:

Take the medicine XGEVA® (denosumab)
Have low blood calcium
Cannot take daily calcium and vitamin D
Had parathyroid or thyroid surgery (glands located in your neck)
Have been told you have trouble absorbing minerals in your stomach or intestines (malabsorption syndrome)
Have kidney problems or are on kidney dialysis
Are taking medicine that can lower your blood calcium levels
Plan to have dental surgery or teeth removed
Are pregnant or plan to become pregnant
Females who are able to become pregnant:
- Your healthcare provider should do a pregnancy test before you start treatment with Prolia®.
- You should use an effective method of birth control (contraception) during treatment with Prolia® and for at least 5 months after your last dose of Prolia®.
- Tell your doctor right away if you become pregnant while taking Prolia®.
Are breast-feeding or plan to breast-feed

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.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Indications

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.

Please see Prolia^® full Prescribing Information and Medication Guide.

Indications

You are now leaving Prolia.com

Prolia^® is covered by many Medicare and Commercial plans.* Learn more about paying for Prolia^®

*Individual patient out of pocket costs will vary

I am on Medicare

I have commercial insurance (e.g. self-purchased or through an employer)

Helping eligible commercially insured patients lower out-of-pocket costs

I am uninsured

Important Safety Information

Indications

Important Safety Information

Prolia® is covered by many Medicare and Commercial plans.* Learn more about paying for Prolia®

*Individual patient out of pocket costs will vary

I am on Medicare

I have commercial insurance (e.g. self-purchased or through an employer)

Helping eligible commercially insured patients lower out-of-pocket costs

Options to enroll in and how to use the Amgen SupportPlus Co-Pay Program.

I am uninsured

Important Safety Information

Indications

Important Safety Information

Prolia^® is covered by many Medicare and Commercial plans.* Learn more about paying for Prolia^®