Are Prolia Injections Covered by Medicare?

Does Medicare pay for Prolia injections? Is it covered by Medicare Part B or Part D? Will my Medicare Advantage plan pay for Prolia treatment? How much does Prolia cost?  prolia covered by medicare

 

Does Medicare pay for Prolia injections?

Prolia is an FDA approved medication for the treatment of osteoporosis, bone loss due to metastasis and multiple myeloma. In some cases this drug is prescribed when Fosamax, Actonel, Bonica and Reclast have produced side effects or were not effective.

Prolia is available by prescription only and must be administered by a medical professional.

Before using this medication tell your doctor about your medical history.  If you have low calcium levels or kidney problems Prolia may not be right for you.

Do not use this drug with herbal supplements without your doctors knowledge and consent.

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Is Prolia covered by Medicare Part B or Part D?

Prolia is administered in your doctors office or a medical clinic. The drug could be considered a covered item under Medicare Part B if Medicare determines the drug is medically necessary. Pre-authorization is required before Medicare will pay for your treatment.

Medicare supplement plans are ideal for those who take Prolia. If you are taking this medication you should consider a Medigap plan that covers essentially all of your Medicare Part B expenses without a large out of pocket expense.

Some Medicare Advantage plans may not pay for the medication until you have gone through a step therapy regiment. If lower cost medications are just as effective your Advantage plan may require you to use those drugs vs. the more expensive Prolia. In many situations, your out of pocket cost will be considerably greater under a Medicare Advantage plan vs. original Medicare and Medigap coverage.

 

How much does Prolia cost?

Prolia is expensive. About $1000 per injection.  If you will be taking this medication be sure you have good coverage.

When you have Medicare supplement plan F your out of pocket cost under Medicare Part B is $0

Shop and compare Georgia Medicare supplement plans.

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This question originally answered on Insurance Library.

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