Prolia is a brand-name prescription medication. The Food and Drug Administration (FDA) has approved it to treat osteoporosis in certain adults. It’s also used to reduce the risk of bone fracture in certain adults who have an increased risk of fracture.
For more information about Prolia’s uses, refer to this article.
Here are some details about Prolia, which is a biologic:
- Active ingredient: denosumab
- How it’s given: subcutaneous injection by your doctor or another healthcare professional
- Biosimilar version: not currently available
Read on to learn about Prolia injections (shots) and cost, as well as how to save money on prescriptions. You can also find information about assistance with costs.
As with all medications, the cost of Prolia can vary. Factors that may affect the price you’ll pay include:
- your treatment plan
- your insurance coverage
- the cost of the visit to your doctor to receive doses of Prolia
- whether Prolia has a savings program (see the “Financial and insurance assistance” section below)
To find out what the cost of Prolia will be for you, talk with your doctor or insurance provider.
Note: If you have insurance, your insurance company may require prior authorization before it covers Prolia. This means the company and your doctor will discuss Prolia in regard to your treatment. The insurance company will then determine whether the medication is covered. If a drug requires prior authorization but you start treatment without the prior approval, you could pay the full cost of the medication. You can ask your insurance company whether Prolia requires prior authorization.
The manufacturer of Prolia offers a Prolia copay program for people with commercial insurance. This is similar to a Prolia copay assistance program. You can use this copay card after your insurance has been applied to the cost of the drug. For more information and to find out if you’re eligible for the Prolia copay card, call 844-369-9962 or visit the program website.
This Prolia manufacturer coupon is not available for people that have government-funded insurance, such as Medicare or Medicaid. So, if you have these insurance plans, talk with your doctor or your insurance provider about what your Prolia copay may be. They may be able to suggest other ways that you can save on the cost of Prolia.
If you don’t have insurance, you’re not eligible for this Prolia copay card. For more information on savings, see the “Financial and insurance assistance” section below. You can also talk with your doctor or pharmacist.
Prolia is available only as a brand-name biologic drug. Currently, it doesn’t come in a biosimilar version. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Also, biosimilars tend to cost less than brand-name medications.
WHY ARE COSTS DIFFERENT FOR BIOLOGIC DRUGS VS. BIOSIMILAR DRUGS?
Biologic drugs can be expensive because of the research needed to test their safety and effectiveness. The manufacturer of a biologic drug can sell it for up to
12 years. When the biologic drug’s patent expires, multiple manufacturers can create biosimilar versions. This marketplace competition may lead to lower costs for biosimilars. Also, because biosimilars are very similar to biologic drugs, they don’t require the same costly testing.
If you need financial support to pay for Prolia, or if you need help understanding your insurance coverage, help is available. For example:
- A program called Prolia Co-pay Program is available for Prolia. For more information and to find out if you’re eligible for support, call 844-369-9962 or visit the program website.
- If you don’t have insurance or if your insurance doesn’t cover Prolia, you may qualify for assistance through the drug manufacturer’s Amgen Safety Net Foundation. For more details and to find out if you qualify, call 888-762-6436 or see the program website.
- Some websites provide details about drug assistance programs, ways to make the most of your insurance coverage, and links to savings cards and other services. Two such websites are:
To learn more about saving money on prescriptions with or without insurance, check out this article.
Here are answers to some frequently asked questions about drug cost and Prolia.
What’s the cost of Prolia with Medicare?
The cost of Prolia with Medicare depends on many factors. These include your particular Medicare plan and the fees that your doctor’s office may charge to administer your Prolia dose. So, your specific plan may determine your cost of the drug.
The best way to find out how much Prolia may cost with your plan is by contacting your insurance provider or your doctor’s office. They can determine what your cost may be based on your insurance plan.
For more information about Medicare drug coverage, see the “Next Steps” section below.
How can I determine Prolia’s cost per dose?
Prolia’s cost per dose can vary based on certain factors, including:
- your insurance coverage
- your doctor’s fees for giving your dose of Prolia
- whether you qualify for the Prolia copay card (for more information, see the “Prolia copay card” section above)
If you have insurance, the best way to determine how much each Prolia dose may cost is by contacting your insurance company or your doctor’s office. They can determine what your cost may be based on your insurance plan.
If you don’t have insurance or if your insurance doesn’t cover Prolia, you may be eligible for other assistance. You may qualify for Prolia cost assistance through the drug manufacturer’s nonprofit called Amgen Safety Net Foundation. This is based on your income and other factors. To find out if you qualify, call 888-762-6436 or see the program website.
Now that you’ve learned about cost and Prolia, you may still have some questions. Talk with your doctor or pharmacist, who can provide personalized guidance about cost issues related to Prolia. However, if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you would pay for Prolia.
Here are some other resources you may find helpful:
- Medicare drug coverage. To learn about Medicare coverage for drugs, see these articles about Medicare Prescription Drug Plans, drug coupons and Medicare, and the Medicare drug list.
- More details. For details about other aspects of Prolia, refer to this article.
- Information about osteoporosis. For more information about your condition, see our list of osteoporosis articles. This list of bone and orthopedic articles may also be helpful.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.