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 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 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.
How often will Medicare pay for Prolia injections?
The average out-of-pocket (OOP) cost for Prolia® through Medicare Part D is $115‡ every 6 months, which equals $19.16 per month. For patients with limited income: Medicare beneficiaries may qualify for Extra Help, a program to help pay for medication costs through Medicare Part D.
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.
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 Part D pay for Prolia?
Do Medicare prescription drug plans cover Prolia? Yes. 97% of Medicare prescription drug plans cover this drug.
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.
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).
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.
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.
Does Medicare Part D pay for Prolia?
Do Medicare prescription drug plans cover Prolia? Yes. 97% of Medicare prescription drug plans cover this drug.
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®.
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.
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.
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 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.
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 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 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.
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 ®.
Is Amgen a nonprofit?
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 ®.
Who issued the Prolia card?
The Prolia ® Co-pay Program Prepaid MasterCard ® is issued by Comerica Bank pursuant to license by MasterCard International Incorporated. No cash or ATM access. MasterCard is a registered trademark of MasterCard International Incorporated. This card can be used only to cover co-payment for eligible prescriptions covered under the program at participating merchant locations where Debit MasterCard is accepted.
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 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).
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.
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 Amgen respect privacy?
Amgen respects the privacy of your personal health information. To learn more, please see our Privacy Statement.
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 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.
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.
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.