Does Medicare Cover Prolia?

Medicare Part A and Medicare Part B may cover Prolia for women who qualify.

If Medicare covers your cost of Prolia treatment, you will typically be required to pay certain Medicare out-of-pocket costs.

A Medicare Part D plan can help cover Prolia treatment costs such as Medicare deductibles, coinsurance, copays and more.

Medigap plans can help cover Prolia costs such as Medicare coinsurance and deductibles.

When Does Medicare Pay for Prolia?

Original Medicare may cover injectable osteoporosis drugs such as Prolia for women who:

• Are enrolled in Medicare Part B

• Meet Medicare’s requirements for getting home health services

• Have a bone fracture that is related to post-menopausal osteoporosis

• Have received a doctor’s certification that they (or their caretaker) are unable to administer the injection

Medicare Part B also covers bone density measurements (bone mass measurements) once every 24 months if you meet one of the following conditions:

• You're a woman determined to be estrogen deficient or at risk for osteoporosis by your doctor

• X-rays show you have possible osteoporosis, osteopenia or fractured vertebrae.

• You take prednisone or steroid-type drugs

• You have primary hyperparathyroidism.

• You're currently taking an osteoporosis drug like Prolia

How Much Does Prolia Cost With Medicare?

The average Medicare Part D beneficiary pays 20% of Medicare’s approved cost of the drug. For Prolia, this amounts to $2,868 a year. 

You must meet your Medicare Part B deductible ($240 per year in 2024) before Medicare will pay its share of a Prolia cost. 

You can also consider enrolling in a Medicare Part D prescription drug plan to get help paying for some of your prescription drugs.

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

How Does Prolia Work? 

Osteoporosis occurs when the body loses too much bone or regenerates too little bone. The result is that your bones can become brittle and can break more easily.

Prolia works by preventing the development of cells that remove old bone. The drug is administered as a twice-a-year injection that is administered under one’s upper arm, upper thigh or abdomen.

Medigap Plans Can Help Cover Prolia Injection Costs

Medicare Supplement Insurance (Medigap) plans help cover some of Medicare's out-of-pocket costs, including at least partial coverage for:

• Medicare Part A coinsurance and hospital costs

• Medicare Part B coinsurance or copayment

• First three pints of blood

• Part A hospice care coinsurance or copayment

If Medicare Part B covers your Prolia treatment, a Medigap plan could help pay your Part B coinsurance costs.

A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.