How much does the Prolia® program cover?
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 ®.
What is *access to Prolia?
*Access is defined as the ability for a patient to obtain Prolia ®, although patient out-of-pocket cost and insurance requirements may vary. †Access data based on DRG covered lives as of Q2 2018.
How do I stop using the Prolia® co-pay program?
If at any time patients begin receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patients will no longer be able to use this card and you must call the Prolia® Co-pay Program at 844-369-9962 (8:00 am-8:00 pm EST, Monday-Friday) to stop participation.
How do I contact the FDA about Prolia®?
Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. 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.
Is there a patient assistance program for Prolia?
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 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.
Does Prolia require prior authorization?
All requests for Xgeva (denosumab), Prolia (denosumab) require a prior authorization and will be screened for medical necessity and appropriateness using the criteria listed below.
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).
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.
Who can give Prolia injections?
It is usually injected by a doctor or nurse in a medical office or clinic. Denosumab injection (Prolia) is usually given once every 6 months.
What is CPT J0897 used for?
HCPCS code J0897 should be used to report denosumab (Prolia™, Xgeva™) for claims submitted to the Part A and Part B MAC.
Does Medicare require prior authorization for infusions?
Does Medicare Require Prior Authorizations? Beneficiaries with Original Medicare (Part A and/or Part B) generally do not need to obtain a prior authorization form for most Medicare services, such as doctor's visits, hospitalizations, diagnostic studies or treatments.
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.
Does Medicare cover Prolia for osteoporosis?
Yes. 97% of Medicare prescription drug plans cover this drug.
What is the best and safest treatment for osteoporosis 2022?
Risedronate – Risedronate (brand names: Actonel, Atelvia) reduces the risk of both vertebral and hip fractures. Risedronate is approved for both prevention and treatment of osteoporosis. It can be taken once per day, once per week, or once per month.
Is there a generic for Prolia injection?
Denosumab (Prolia) is used to treat osteoporosis in women after menopause and in men. This drug is more popular than comparable drugs. There are currently no generic alternatives to Prolia. It is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower.
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®.
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 ...
What are the symptoms of an allergic reaction?
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).
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®.
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. Severe jaw bone problems (osteonecrosis) may occur.
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.
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 is Prolia used for?
Prolia® is indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or are intolerant to other available osteoporosis therapy. In postmenopausal women with osteoporosis, Prolia® reduces the incidence of vertebral, nonvertebral, and hip fractures.
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. Prolia® is contraindicated in patients with a history of systemic hypersensitivity to any component of the product. Reactions have included anaphylaxis, facial swelling and urticaria.
