You may be able to find Medicare plan options in your area that cover Prolia. Learn more about Prolia and find Medicare Advantage plans in your area that cover prescription drugs.
Chemical name: Denosumab
Typical dosage: 60mg/ml
Typical type: Injection1
Prolia® is typically used to help treat osteoporosis in men and in women who are at increased risk for weakened bones after menopause. It can also be used to help treat bone loss in cancer patients who are receiving treatment for prostate cancer (men) or breast cancer (women). Prolia is available as an injection.
Prolia is an injection administered by or under the supervision of your doctor. Prolia is typically given every six months and works to both treat and prevent osteoporosis.
Prolia works by inhibiting the activation of osteoclasts, which is what breaks down bones in osteoporosis.
Some common side effects of Prolia can include cold or flu symptoms such as fever, sore throat and chills.
Some less common side effects can include back pain, skin rashes, swelling, muscle or bone pain, frequent urges to urinate, heartburn, difficulty sleeping and others.
How much does Prolia cost with Medicare?
Prolia coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.
Contact your plan carrier or consult your plan formulary for more cost information.
Does Medicare cover Prolia?
According to GoodRx, 98% of Medicare Advantage plans and Medicare Part D plans covered Prolia in 2023.1
Medicare Advantage plans or Part D plans that cover Prolia include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.2
Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.
Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Prolia. We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.
Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.
Written by Hayden Gharibyar, Pharm.D.
1 GoodRx. Prolia. Retrieved October 2023, from www.goodrx.com/Prolia/medicare-coverage.
A formulary for Medicare is the list of drugs a given Medicare Part D prescription drug plan or Medicare Advantage Prescription Drug (MA-PD) plan will cover. A Medicare plan formulary details information such as how drugs are covered, their relative costs, limitations and/or restrictions. Read more