Prolia® Medicare Coverage

Prolia is an injection administered by or under the supervision of your doctor. Prolia is typically given every six months and works to both treat and prevent osteoporosis.

Prolia works by inhibiting the activation of osteoclasts, which is what breaks down bones in osteoporosis.

Some common side effects of Prolia can include cold or flu symptoms such as fever, sore throat and chills.

Some less common side effects can include back pain, skin rashes, swelling, muscle or bone pain, frequent urges to urinate, heartburn, difficulty sleeping and others.

How much does Prolia cost with Medicare?

Prolia coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Prolia?

According to GoodRx, 98% of Medicare Advantage plans and Medicare Part D plans covered Prolia in 2023.¹

• Medicare Advantage plans or Part D plans that cover Prolia include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.²
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Prolia. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Additional information

Prolia should be given by a licensed healthcare provider in a healthcare facility.

Do not take Prolia if you are pregnant or planning on becoming pregnant. Do not become pregnant for 5 months after you stop taking it.

Make sure you get plenty of calcium and vitamin D while taking Prolia (unless otherwise directed by your doctor).

You may be at increased risk for infection while taking Prolia. Avoid people who are sick while taking this drug.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.