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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

Prolia® is broadly covered by Medicare and commercial health plans nationwide.1-3*

100%
Coverage for
Medicare Part B1†

95%
Coverage for
Medicare Part D2†

81%
Coverage for
Commercial Plans3†
  • *Please see plan-specific requirements.
  • 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.
Medicare Part B

79% of Prolia® syringes cost Medicare Part B patients $0 OOP, according to benefit verification data4*†‡

OOP Costs for Medicare Part B Patients per Prolia® Syringe (% of Syringes)4*

Medicare Part B Chart
These data do not include medical benefit OOP costs related to office visits or administration of Prolia®. This sample includes Medicare patients with supplemental/secondary coverage (e.g., Medigap) that may require additional monthly premiums. Individual OOP costs will vary.
  • *Data reflect insurance verifications for Medicare Part B patients only (N = 102,458), not actual claims, completed by ProliaPLUS® from January 1, 2015 to December 31, 2015.
  • OOP costs identified in insurance verification data as a percentage (e.g., co-insurance) were converted to dollars using the Medicare Part B Reimbursement Rate for Q4, 2015, which was $914.10.
  • Costs for patients covered by Medicare Part C (Medicare Advantage) vary by plan.
The cost information provided is for informational purposes only; policies change periodically and often without warning. If you have questions about OOP costs, contact the payer.

100% of Medicare Part B beneficiaries have Prolia® coverage with no prior authorization required1*

  • All Medicare Administrative Contractors cover Prolia®
  • There are no prior authorizations under Medicare Part B5†
  • PA may be required under Medicare Part C (Medicare Advantage)
Prolia® has
confirmed medical
benefit coverage
nationwide.1
  • *Data as of February 2016.
  • Individual plans may request documentation to confirm administration is consistent with the Prolia® label.
  • 53% of patients covered by Medicare Part C (Medicare Advantage) plans require Prior Authorization. Data reflect insurance verifications for Medicare Part C (Medicare Advantage) patients (N = 50,099), not actual claims, completed by ProliaPLUS® from January 1, 2015 to December 31, 2015.

Verify your patients' insurance coverage with ProliaPLUS®

Our support program can refer eligible Medicare Part B and Medicare Part D patients to independent co-pay foundations, which may be able to provide financial assistance
Medicare Part D

Approximately 60% of Prolia® syringes cost Medicare Part D patients no more than $10 out of pocket (OOP)6*

OOP Costs for Medicare Part D Patients per Prolia® syringe (% of Syringes)6*

Medicare Part D Chart
For 72% of Medicare Part D patients with a co-pay less than $100 per syringe, the approximate cost is $15 per month.
These pharmacy claims data do not include deductibles or any other physician-related service fees associated with administration of Prolia® (eg, doctor visits). OOP costs may vary by patient and/or injection.
  • *Data reflect IMS Formulary Impact Analyzer Prolia® Medicare Part D claims (N=20,204), January 2015 to September 2015. Data from commercial patients were not included in these analyses.
  • The cost information provided is for informational purposes only; policies change periodically and often without warning. If you have questions about OOP costs, contact the payer.

95% of Medicare Part D beneficiaries have coverage for Prolia®, over half with no prior authorization (PA) required2*

Prolia® has confirmed medical benefit coverage nationwide.2*
Prolia® is covered by the following top Medicare Part D plans2,7,8
Aetna/Coventry
NO PA REQUIRED
Anthem/Blue Cross Blue Shield affiliates
-
Cigna-HealthSpring
NO PA REQUIRED
CVS Caremark/SilverScript/Health Net
NO PA REQUIRED
Express Scripts
PA MAY BE REQUIRED§
Humana
NO PA REQUIRED
Prime Therapeutics/MedicareBlue Rx/BlueRx
PA MAY BE REQUIRED
Rite Aid/EnvisionRx
NO PA REQUIRED
United Healthcare/AARP/OptumRx
-
WellCare
NO PA REQUIRED
  • *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.
  • Plans are listed in alphabetical order; list includes top plans based on covered lives that cover Prolia®.
  • Plan requires an electronic step edit.
  • §Some plans under Express Scripts may require a PA.
  • MedicareBlue Rx, representing BCBS of MN, MT, NE, ND, and WY, does not require a PA. Blue Cross MedicareRx, representing BCBS of IL, NM, OK, and TX, requires a PA. Other Blue plans affiliated with Prime Therapeutics may or may not require a PA.
The coverage information provided is for informational purposes only and should in no way be considered a guarantee of coverage or reimbursement for any product or service; policies change periodically and often without warning. The responsibility to determine coverage and reimbursement parameters for a particular patient is always the responsibility of the provider or physician.
Verify your patients' insurance coverage with ProliaPLUS®
Our support program can refer eligible Medicare Part B and Medicare Part D patients to independent co-pay foundations, which may be able to provide financial assistance

Medicare provides coverage of DXA scans for9:

  • Women identified by a physician as estrogen deficient and at clinical risk of osteoporosis
  • Women and men with vertebral abnormalities indicative of osteoporosis and vertebral fracture
  • Women and men currently receiving an FDA-approved medication for osteoporosis
Commercial
$25
OOP Cost

With the Prolia® Co-pay Card, eligible patients with commercial insurance can pay $25 or less

Explore Financial Assistance

Commercially Insured Lives With Medical Benefit Coverage for Prolia®3

19% have commercial coverage with policy language more restrictive than FDA-approved indication

Approximately 60% of commercially insured Prolia® patients did not require Prior Authorization10

  • Data reflect insurance verifications (N=46,182), not actual claims, for commercially insured patients submitted to and completed by ProliaPLUS® in 2015.
  • *Plans may require that patient either fails or is intolerant to another osteoporosis medication. Please see plan-specific requirements.
  • 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.
  • For example, multiple bisphosphonate trials, or limited inclusion criteria.

Verify your patients' insurance coverage with ProliaPLUS®

Our support program can help verify patient coverage and out-of-pocket costs for Prolia®—with results sent directly to your office.