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Indications

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 Read More

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.

Prolia® is indicated for treatment to increase bone mass in men 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.

Prolia® is indicated as a treatment to increase bone mass in men at high risk for fracture receiving androgen deprivation therapy for nonmetastatic prostate cancer. In these patients Prolia® also reduced the incidence of vertebral fractures.

Prolia® is indicated as a treatment to increase bone mass in women at high risk for fracture receiving adjuvant aromatase inhibitor therapy for breast cancer. Close

Coverage information and fullfillment options to help your patients get Prolia®

100% Medicare Part B
Coverage1*
95% Medicare Part D
Coverage2*
81% Commercial
Coverage3*

*Medicare Part B: Data as of February 2016. Medicare Part D: For the treatment in postmenopausal women with osteoporosis at high risk for fracture. Prescription Drug Plans covering 95% of Part D beneficiaries include Prolia® on their formularies. Policies for the remaining 5% of beneficiaries were not reviewed. Commercial: Based on analysis of coverage under the medical benefits of 98 US commercial plans for 169 million targeted commercial lives; data as of February 24, 2016.

Learn about coverage and out-of-pocket costs for Prolia® Explore Coverage

Read more about ICD-10 and J-code information below. Read More

Connect with
preferred distributors
To order Prolia® for your office directly from one of our preferred distributors, browse our Helpful Links page for a list of contact information and credit applications.
Find Preferred Distributors
Verify your patients’
insurance coverage
You can also learn how ProliaPLUS® can help verify patient coverage and out-of-pocket costs for Prolia®, with results sent directly to your office.
Explore Insurance Support
Explore Prolia® injection network locations
To refer your patients to a healthcare facility to receive their Prolia® injection, you can explore our searchable Prolia® injection network locations database.
Explore Injection Networks
Verify your patients’
insurance coverage
You can also learn how ProliaPLUS® can help verify patient coverage and out-of-pocket costs for Prolia®, with results sent directly to your office.
Explore Insurance Support
Find a specialty or
local
pharmacy
To connect patients with specialty or
local retail pharmacies to fill their Prolia®
prescriptions, explore our searchable
pharmacy database.
Find a Pharmacy
Explore
fulfillment through
specialty pharmacies
Specialty pharmacies can provide coordinated delivery and services to help Prolia® patients start and stay on therapy. These additional services may include:
  • Insurance coverage investigation and prior authorization process support
  • Next injection reminders and prescription refills
Some health plans require a specific specialty pharmacy
to be used ("mandated specialty pharmacies"). See your patient’s plan for specific
policies, instructions and requirements

Learn how to help patients find support and explore their financial assistance options

Schedule next injection appointments for Prolia® patients in your office

Image representing an example of 6-month dosing
  • Single-use prefilled 1 mL syringe
  • This image is for illustration purposes only and represents a snapshot in time. Actual dosing and duration of a particular patient's therapy should be based upon the product's approved labeling and the independent clinical decision of the provider.

Schedule your patient’s injection appointments every 6 months, and learn about treatment reminders for your patients and your practice.

Learn About Treatment Reminders
Prolia® is administered as 1 shot every 6 months4
  • 60 mg subcutaneous injection in the upper arm, upper thigh, or abdomen by a healthcare professional
  • Pre-existing hypocalcemia must be corrected prior to initiating therapy with Prolia®. Adequately supplement all patients with calcium and vitamin D
  • Multiple vertebral fractures have been reported following Prolia® discontinuation

Coding and Billing Information

On average, Prolia® claims are paid by Medicare within 15 days5‡

The permanent J-code for Prolia® for Medicare claim processing: J0897 (Injection, denosumab, 1 mg).6

ICD-10 Codes:

Some payers may require providers to include ICD-10-CM diagnosis codes on medical claims for Prolia®. Learn about examples of ICD-10 codes that may be appropriate for your patients.

  • Based on analysis of 6216 Medicare claims from January 2015 to October 2015 for Prolia® (includes claims paid on the first submission).
  • Any information is of general nature only and not intended to be directive or a guarantee of reimbursement. Coding, billing, and coverage policies change periodically and often without warning. The responsibility to determine coverage and reimbursement parameters—and appropriate coding for a particular partient and/or procedure—is always the responsibility of the provider or physician.