PROLIA 60 mg/mL Injection
Also known as Denosumab. Coverage in Oregon and Washington (CMS PDP Region 30).
5 of 10 stand-alone Part D plans in Oregon and Washington cover this drug on tier 4.
5 of 5 plans apply a prior authorization, step therapy or quantity limit.
56 Medicare Advantage plans in OR, WA do cover it
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. OR: 19 plans · WA: 37 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1854.5439 | $315.270.17 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | — | $1850.5386 | $314.590.17 units |
|
| Humana Value Rx Plan (PDP)$22.10/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $1850.5386 | $314.590.17 units |
|
| HealthSpring Extra Rx (PDP)$50.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $1852.8701 | $314.990.17 units |
|
| Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $1850.5386 | $314.590.17 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.