Full Answer
How much does Prolia cost without insurance?
The list price for one dose of Prolia was around $1,300 as of October 2021, according to Amgen, the manufacturer of the drug. Most people get one Prolia injection every six months, making the average cost for one year of treatment with no insurance or Medicare coverage around $2,600.
How does Medicare cover Prolia?
Medicare plans typically list Prolia in Tier 4 of their formulary. You pay 20% of the Medicare-approved amount for the cost of the drug, and the Part B deductible applies. You pay nothing for the home health nurse visit to inject the drug. To find out how much your test, item, or service will cost, talk to your doctor or health care provider.
Does your Medicare insurance plan cover Prolia?
Yes! 99% of Medicare Advantage plans and Medicare Part D plans cover Prolia. 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
Does Medicare cover Prolia for osteopenia?
Prolia is often covered by Medicare. Which part of Medicare provides coverage and how much you can expect to pay out of pocket for the treatment depends on numerous factors, but Part B is usually what covers Prolia.
Does Prolia have a patient assistance program?
Amgen Safety Net Foundation 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 or have insurance that excludes Prolia®.
How can I reduce the cost of Prolia?
Here are some ways that may lower the cost of your Prolia prescription.Instead of Medicare, Use a Coupon. If your Medicare co-pay is higher than $1400.91, you can save money by using a GoodRx coupon instead. ... Manufacturer Coupon. Pay as little as $25 for each fill with insurance. ... Patient Assistance Program from Amgen.
How much should a Prolia shot cost?
Prolia prices without insurance will vary depending on where you buy it, but you can expect to pay around $2,560 for a single 60 ml/mg syringe of Prolia.
What is the Medicare allowed amount for Prolia?
99% of Medicare Part D patients have access* to Prolia. The average out-of-pocket (OOP) cost for Prolia® through Medicare Part D is $115‡ every 6 months, which equals $19.16 per month.
How much does Prolia cost at Walmart?
For every 1, 1ML of 60MG/ML Solution Prefilled Syringe, the average retail price of Prolia is around $1,829.7....Average 12 Month Prices for Prolia.PharmacyProlia Retail PriceProlia SingleCare PriceWalmart$1689.97$1429.68Walgreens$1768.76$1496.404 more rows
How long does it take for Prolia to improve bone density?
They reported that “denosumab (Prolia in 14, 60, and 100 mg doses) showed significant increases in percent BMD (bone mineral density) values of lumbar spine and total hip from baseline in 12 months.
Does Medicare Advantage pay for Prolia?
The majority of commercial and Medicare plans cover Prolia®. The list price for Prolia® is $1,477.16* ,† per treatment every six months.
Does Prolia cause weight gain?
Prolia (denosumab) has not been associated with weight gain in clinical studies. Prolia can cause peripheral edema (fluid retention) or swelling, and this may lead to weight gain in some people. Speak with your doctor if you have any side effect that bothers you or that does not go away.
What is the most common side effect of Prolia?
Bone pain. Pain, specifically musculoskeletal pain, is one of the most common side effects of Prolia.
What type of doctor gives Prolia injections?
Rheumatologists treat patients with age-related bone diseases. They can diagnose and treat osteoporosis. Endocrinologists, who see patients with hormone-related issues, also manage the treatment of metabolic disorders such as osteoporosis. Orthopedic surgeons may fix fractures.
Does Medicare cover bone density shots?
Medicare covers bone density screening under Part B (medical insurance) every 24 months (or more often if medically necessary) as long as you meet one or more specific conditions, outlined by Medicare.gov.
What is the best injection for osteoporosis?
Denosumab injection (Prolia) is used treat osteoporosis that is caused by corticosteroid medications in men and women who will be taking corticosteroid medications for at least 6 months and have an increased risk for fractures or who cannot take or did not respond to other medication treatments for osteoporosis.
Does Medicare cover Prolia or Reclast?
Injectable Drugs Coverage Medicare Part A or Medicare Part B will pay for a portion of the cost of osteoporosis medications delivered intravenously or by injection. These medications may include ibandronate (Boniva), zoledronic acid (Reclast), denosumab (Prolia) and sometimes calcitonin (Miacalcin).
Are doctors paid to prescribe Prolia?
Expensive drugs like denosumab (Xgeva, Prolia), also for osteoporosis, are sometimes covered under the patient's prescription plan but are shipped to the practice from a specialty pharmacy.
What is the cost of Prolia in Canada?
Denosumab is available as a 60 mg/mL pre-filled syringe at a cost of $357.90 (Ontario Drug Benefit, June 2015). At the recommended dose of 60 mg every six months, the annual cost of denosumab is $716.
Is Prolia a Tier 4 drug?
Medicare plans typically list Prolia in Tier 4 of their formulary. You pay 20% of the Medicare-approved amount for the cost of the drug, and the Part B deductible applies.
What is the Amgen Safety Net Foundation?
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 or have insurance that excludes Prolia ®.
What is a Prolia copay?
Program Details: The Prolia ® Co-pay Program is a coupon program that provides financial support for eligible commercially insured patients. For eligible patients, program covers the amount of OOP cost for Prolia ® that exceeds $25, up to a maximum benefit of $1,500 per patient, per 12-month enrollment period. Patient is responsible for costs above this amount. The program does not provide support for supplies, procedures, or any physician-related services associated with Prolia ®.
How much does Prolia cost?
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. †††
What is the WAC of Prolia?
*List price is also referred to as wholesale acquisition cost or WAC. WAC is the price at which Amgen sells its products to wholesalers. Prolia is an injection administered by a healthcare professional once every six months.
How long after Prolia can you use birth control?
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®.
How to report side effects of prescription drugs?
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.
What are the symptoms of a fractured thigh bone?
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®.
What is the Prolia Amgen first step program?
Prolia Amgen First Step Program: Eligible commercially insured patients may save on their out-of-pocket medication costs; for additional information contact the program at 888-427-7478.
What is Prolia used for?
Prolia (denosumab) is a member of the miscellaneous bone resorption inhibitors drug class and is commonly used for Osteoporosis.
How much does a free drug card save?
The free Drugs.com Discount Card works like a coupon and can save you up to 80% or more off the cost of prescription medicines, over-the-counter drugs and pet prescriptions.
How long do you have to live in the US to be a US citizen?
Yes, must have lived in the US or its territories for 6 months or longer .
When there is a range of pricing, should consumers expect to pay the lower price?
Important: When there is a range of pricing, consumers should normally expect to pay the lower price. However, due to stock shortages and other unknown variables we cannot provide any guarantee.
Fulfill Through Buy & Bill
Find resources and support for offices that purchase Prolia ® through authorized wholesalers (or schedule treatment at alternate sites of care).
Fulfill Through Pharmacy
Explore resources and support for offices that obtain Prolia ® through a retail or specialty pharmacy.
Referrals to Independent Co-pay Foundations
Amgen Assist ® can refer patients, as a courtesy, to independent co-pay foundations.*
Referrals to Amgen Safety Net Foundation
Amgen Safety Net Foundation 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 or have insurance that excludes Prolia ®.
What is Prolia used for?
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 ...
Can you stop Prolia?
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.
Can you take Prolia while pregnant?
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®.
Can Prolia cause muscle pain?
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.
Does Prolia cause back pain?
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.
Can Prolia cause endocarditis?
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.
Can Prolia cause jaw problems?
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®.
How long does it take to activate Amgen First Step card?
Ongoing activation of the Amgen FIRST STEP™ card is contingent on the submission of the required Explanation of Benefits (EOB) form by your healthcare provider’s office within 45 days of use of the Amgen FIRST STEP™ card. Patients will be responsible for reimbursing the program for all amounts paid out if the EOB for the date of service is not received within 45 days.
What is the first step program?
The Amgen FIRST STEP TM Program is a co-pay card program that can help eligible commercially insured patients meet their deductible, co-insurance, and co-payment.
Does Prolia lower calcium levels?
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.
Can you take Xgeva with Prolia?
If you receive Prolia ®, you should not receive XGEVA ®. Prolia ® contains the same medicine as XGEVA ® (denosumab).
What are the risks of a weakened immune system?
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.
Can you take Prolia while pregnant?
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 are the symptoms of a fractured thigh bone?
Some people have developed unusual fractures in their thigh bone. Symptoms of 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®.
Are you a patient struggling to afford the cost of medical treatments?
When health insurance is not enough , we’re here to help — with copays, premiums, deductibles and out-of-pocket expenses for supplies, supplements, surgeries and more. We offer financial assistance through a number of Disease Funds, with new funds opening every year, so you can get the care you need.
What is the disease fund?
The Disease Fund (s) under which your medication is covered will appear. Please note: To get coverage for a medication, it must be covered under the specific diagnosed disease for which you are applying.
What to do before you start taking medication?
Before you begin, be sure to contact the company that makes your medication. Manufacturers have generous assistance programs that often exceed what most non-profit foundations can offer, particularly for commercially insured patients. LEARN MORE
Can HealthWell change pharmacy?
HealthWell reserves the right to change its program in its entirety or with respect to any applicant at any time with or without notice. HealthWell does not restrict the provider or pharmacy a patient selects. Patients are free to change medications, providers or pharmacies at any time.
Can HealthWell assist in the United States?
HealthWell can only assist individuals who are receiving treatment in the United States.
Apply for patient financial assistance
Need help paying for treatments? We offer a fast, reliable way to get patient financial assistance. Apply for yourself or your patients today.
More information about applying for patient financial assistance
To qualify for a financial assistance program, you (or the patient you’re applying for) must:
What is the Amgen Safety Net Foundation?
Since 2001, the Amgen Safety Net Foundation (ASNF) has helped hundreds of thousands of patients with financial need gain access to Amgen medicines at no cost. This is a modal window.
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Is Amgen Safety Net Foundation billed monthly?
If you are being charged a monthly fee for support from the Amgen Safety Net Foundation, the organization billing you is not the Amgen Safety Net Foundation and you are being charged for support that the Amgen Safety Net Foundation can provide to you directly at no cost.
Does Amgen charge for patient assistance?
Check the status of your patient's application. Provider Access. Amgen Safety Net Foundation does not charge patients a fee for its assistance. Amgen Safety Net Foundation is not affiliated with third parties who charge a fee for assistance with enrollment or medication refills.
