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 (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®.
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.
Does Medicare Part D pay 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 per year?
While generic Fosamax costs roughly $100 to $200 per year and brand-name bisphosphonates slightly less than $1,000 per year, Prolia will cost about $1,650 per year plus the cost associated with an office visit. Prolia is also more expensive than Reclast, which costs $1,100 for a yearly dose.
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.
What Medicare tier is Prolia?
What drug tier is Prolia typically on? Medicare prescription drug plans typically list Prolia on Tier 4 of their formulary. Generally, the higher the tier, the more you have to pay for the medication.
What is the alternative to taking Prolia?
Are there alternatives to Reclast and Prolia for osteoporosis? There are several other medications that can be used to treat and/or prevent osteoporosis, such as: Other bisphosphonates besides Reclast: Examples of others include ibandronate (Boniva) and alendronate (Fosamax).
Is Prolia shot covered by Medicare Part B?
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).
Is taking Prolia worth the risk?
Are there any dangers of using this drug? Studies have found that Prolia is generally safe and effective to treat osteoporosis and certain types of bone loss. For example, in the studies, people taking Prolia for up to 8 years didn't have significant side effects compared with people taking a placebo.
When will Prolia go generic?
The patents on Prolia/Xgeva will expire in the US on 19 February 2025 and will expire in Europe on 25 June 2022, except for France, Italy, Spain and the UK, where they will expire in 2025 [1]. Some of the denosumab biosimilars and non-originator biologicals* approved or in development are presented in Table 1.
Does Prolia reverse osteoporosis?
Denosumab (Prolia®, Xgeva®) reversed cortical bone loss and increased bone mineral density, lowering wrist fracture rates in women with osteoporosis, according to new research. Osteoporosis is a common condition where bones become weak, affecting both men and women, mainly as they grow older.
How can I get Prolia for free?
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®.
Is taking Prolia worth the risk?
Are there any dangers of using this drug? Studies have found that Prolia is generally safe and effective to treat osteoporosis and certain types of bone loss. For example, in the studies, people taking Prolia for up to 8 years didn't have significant side effects compared with people taking a placebo.
What is the best and safest treatment for osteoporosis 2022?
Bisphosphonates are usually the first choice for osteoporosis treatment. These include: Alendronate (Fosamax), a weekly pill. Risedronate (Actonel), a weekly or monthly pill.
What Medicare tier is Prolia?
What drug tier is Prolia typically on? Medicare prescription drug plans typically list Prolia on Tier 4 of their formulary. Generally, the higher the tier, the more you have to pay for the medication.
If you have commercial insurance
The Amgen FIRST STEP™ Program can help eligible commercially insured patients meet their deductible, co-insurance, or co-payment. ‡
If you have government insurance like Medicare
Amgen Assist 360™ can refer patients to independent nonprofit patient assistance programs that may be able to help them afford the co-pay costs for their prescribed medicine. †
For uninsured patients
Amgen Safety Net Foundation is a nonprofit patient assistance program sponsored by Amgen that helps qualifying patients access Amgen medicines at no cost.
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®.
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 (denosumab) is a member of the miscellaneous bone resorption inhibitors drug class and is commonly used for Osteoporosis.
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 ® 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.
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 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.
Can Prolia cause low calcium?
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.
Can you take Xgeva with Prolia?
If you receive Prolia®, you should not receive XGEVA®. Prolia® contains the same medicine as XGEVA® (denosumab).
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®.
Does Amgen cover out of pocket medication?
Program covers out-of-pocket medication costs for the Amgen product only. Program does not cover any other costs related to office visit or administration of the Amgen product.
Can Prolia cause jaw problems?
Severe jaw bone problems (os teonecrosis) 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 ®.
Can you take Xgeva with Prolia?
If you receive Prolia ®, you should not receive XGEVA ®. Prolia ® contains the same medicine as XGEVA ® (denosumab).
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 ®.
Does Prolia require private insurance?
Must have private commercial health insurance that covers medication costs for Prolia ®. Must not be a participant in any federal-, state-, or government-funded healthcare program such as Medicare, Medicare Advantage, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), the Department of Defense (DoD), or TRICARE.
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.
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.
For patients with government insurance like Medicare
We provide referrals to independent nonprofit patient assistance programs that may be able to help them afford the co-pay cost of their medicine.**
For uninsured patients
Amgen Safety Net Foundation is a nonprofit patient assistance program sponsored by Amgen that helps qualifying patients access Amgen medicines at no cost.
What are the symptoms of Prolia?
Symptoms have included hypotension, dyspnea, throat tightness, facial and upper airway edema, pruritus, and urticaria. If an anaphylactic or other clinically significant allergic reaction occurs, initiate appropriate therapy and discontinue further use of Prolia®.
How long does it take to monitor calcium levels after Prolia?
In patients predisposed to hypocalcemia and disturbances of mineral metabolism, including treatment with other calcium-lowering drugs, clinical monitoring of calcium and mineral levels is highly recommended within 14 days of Prolia® injection.
Is Prolia contraindicated for hypocalcemia?
Contraindications: Prolia ® is contraindicated in patients with hypocalcemia. Pre-existing hypocalcemia must be corrected prior to initiating Prolia ®. Prolia® is contraindicated in women who are pregnant and may cause fetal harm. In women of reproductive potential, pregnancy testing should be performed prior to initiating treatment with Prolia®.
Does Medicare Part B cover Prolia?
of Medicare Part B patients have access † to Prolia ® as an initial therapy 1,‡
Can you get serious infections while on Prolia?
In patients who develop serious infections while on Prolia®, prescribers should assess the need for continued Prolia ® therapy.
Can Prolia cause muscle pain?
Musculoskeletal Pain: Severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported in patients taking Prolia®. Consider discontinuing use if severe symptoms develop.
Does Prolia cause endocarditis?
Endocarditis was also reported more frequently in Prolia® -treated patients. The incidence of opportunistic infections and the overall incidence of infections were similar between the treatment groups. Advise patients to seek prompt medical attention if they develop signs or symptoms of severe infection, including cellulitis.
