There is an antibody in Prolia (Denosumab) that slows down the weakening of bones. It signals the cells that break bone down, preventing these cells from forming. The FDA has approved twice-a-year Prolia injections to treat osteoporosis in people with a high risk of fractures. It is usually administered to the patient in a doctor’s office.
Possible side effects include serious allergic reactions, low blood calcium, severe jaw bone problems, unusual thigh bone fractures, and increased risk of broken bones. After stopping Prolia, serious infections, skin problems, and bone, joint, or muscle pain, can occur.
Foods that increase bone density are milk, cheese, dairy foods, green leafy vegetables, broccoli (but NOT spinach, and especially NOT fish where you eat the bones, such as sardines).
Prolia is administered in your doctor’s 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 Part A and Medicare Part B help pay for an injectable drug for osteoporosis and visits by a home health nurse to inject the drug, if you meet these conditions:
1)You’re a woman.
2) You’re eligible for Part B and meet the criteria for Medicare home health services.
See Medicare.gov.
You have a bone fracture that a doctor certifies is related to postmenopausal osteoporosis.
Your doctor certifies that you’re unable to learn to give yourself the drug by injection, and your family members and/or caregivers are unable and unwilling to give you the drug by injection.
Most Medicare plans will require you to obtain their authorization before they will provide coverage for this prescription. You’ll need to contact your plan, and they may require you to have your health care provider to fill out paperwork indicating why you need this prescription. If you do not receive authorization or don’t want to go through this process, you may want to consider using a GoodRx discount instead of Medicare to find the best price for this prescription.
Medicare plans typically list Prolia in Tier 4 of their formulary. You pay 20% of the Medicare-approved amount for the cost of the drug, and the Part B deductible applies. You pay nothing for the home health nurse visit to inject the drug.
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things like Other insurance you may have. How much your doctor charges. Whether your doctor accepts assignment. The type of facility, and where you get your test, item, or service.