Does Medicare Part D Cover Prolia Prescriptions?

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  • Prolia (denosumab) is an osteoporosis medication that may help slow bone loss. Certain Medicare plans may provide full or partial coverage for Prolia. Learn more.

Prolia (denosumab) is a monoclonal antibody medication designed to strengthen bones in individuals with osteoporosis. It may also be recommended for people undergoing treatment for certain cancers that weaken the bones and increase the risk of bone fractures. The medication is administered via injection in the arm, thigh or stomach by a healthcare provider. 

Is Prolia Covered by Medicare? 

Approximately 99% of Medicare Advantage and Medicare Part D prescription drug plans cover Prolia. Medicare coverage may vary based on plan availability and geographical location, so beneficiaries should always verify plan specifics with a Medicare advisor to ensure their prescriptions are covered. 

Medicare recipients are generally required to pay the full cost for prescriptions until they meet their Medicare deductibles, which cap off at $480. The full cost for Prolia during the Medicare deductible stage is approximately $95 to $2,072.52. After a recipient meets their required Medicare deductible, they're usually only required to pay a copay or coinsurance percentage for any subsequent covered prescriptions. The cost for Prolia in the post-deductible stage ranges from $80 to $1,557 per prescription. 

Are There Generic Alternatives to Prolia?

Prolia is a biologic drug, which means it cannot be exactly replicated in generic form. However, researchers are currently working on developing biosimilar alternatives to Prolia and other medications containing denosumab monoclonal antibodies. If the development proves to be successful, the potential launch date for the new medications is February 2025.

How Does Prolia Work in the Body? 

Prolia contains monoclonal antibodies that work in the same fashion as natural antibodies produced by the immune system. When Prolia is injected into the body, the monoclonal antibodies target the cells responsible for bone loss and hinder their production, which can help prevent additional bone loss and increase bone mass. Prolia may also help reduce bone pain and prevent complications that sometimes accompany osteoporosis. 

Does Prolia Contain Calcium?

Prolia does not contain calcium. The medication may actually lower calcium levels in the blood, so individuals are sometimes advised to take calcium and vitamin D supplements when being treated with Prolia. 

Does Prolia Weaken the Immune System?

Research has shown that Prolia may alter or weaken the immune system. Prolia targets and inhibits certain immune cells in the body, which researchers believe may affect the overall immune system. Individuals who experience lowered immunity during or following treatment with Prolia may become more susceptible to infections. 

What Are Some Side Effects of Prolia?

Common side effects of Prolia that are generally mild and tend to resolve on their own without medical intervention include dizziness or spinning sensations, heartburn, flatulence and sleep disturbances. Serious, rare side effects that may require immediate medical attention include blood in the stools, darkened urine, loose teeth, swelling, rapid weight gain, and yellowing of the eyes and skin. 

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