Xgeva® Medicare Coverage

Xgeva®
Chemical name: Denosumab

Typical dosage: 120mg/1.7ml

Typical type: Injection1

Xgeva® is a medication typically used to treat high calcium levels due to cancer and to prevent bone fractures and other bone problems caused by multiple myeloma or cancer bone metastases. Xgeva is brand name only and is available as a subcutaneous injection.

Xgeva is a prescription medication that contains the active ingredient Denosumab. Xgeva Is usually given as a subcutaneous injection into the fatty part of the skin every 4 weeks.

Xgeva works by targeting proteins to slow bone breakdown, prevent bone fractures and treat high calcium levels.

The most common side effects of Xgeva include constipation, loss of appetite, feeling tired or weak, nausea, vomiting, diarrhea, back pain, joint pain, headache and signs of a common cold.

Does Medicare cover Xgeva?

Yes! 93% of Medicare Advantage plans and Medicare Part D plans cover Xgeva.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.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 Xgeva.

Find Medicare Advantage plans with drug coverage

Compare Plans

Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

 

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Average costs for Xgeva with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$579 – $2,705 $536 – $2,485

Additional information

Xgeva should be given by a licensed healthcare provider in a healthcare facility.

Do not take Xgeva if you are pregnant or planning on becoming pregnant. Xgeva can cause harm to an unborn baby. Use birth control to prevent pregnancy while you are taking Xgeva and for 5 months after you stop taking it.

You should not use Xgeva if you have a history of low calcium levels. Bone fractures in the leg, skin reactions like eczema and rash and extremely low calcium levels have occurred after starting Xgeva.

The risk of broken bones is higher after stopping Xgeva.

Call your doctor if you have signs of extremely low phosphate levels like change in eyesight, confusioin, mood changes, muscle pain or weakness, shortness of breath, other breathing problems or trouble swallowing.

Jaw bone problems have also occurred in patients taking Xgeva. The risk of jaw bone problems may be higher if you have taken this medication for a long time or if you have cancer, dental problems, dentures that do not fit well, anemia, blood clotting problems or an infection.

Talk to your doctor and be sure to inform your dentist if you are taking Xgeva.

 

 

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.