XGEVA 120 mg/1.7mL Injection

Also known as Denosumab. Coverage in Delaware, DC and Maryland (CMS PDP Region 05).

5 of 10 stand-alone Part D plans in Delaware, DC and Maryland cover this drug on tier 5.

5 of 5 plans apply a prior authorization, step therapy or quantity limit.

27 Medicare Advantage plans in DE, DC, MD 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. DE: 12 plans · DC: 4 plans · MD: 11 plans.

Every plan that covers it

Plan	Tier	30-day preferred	90-day mail	Unit cost	Est. 30-day fill	Restrictions
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$2017.9306	$4,035.862 units	Prior authorization Quantity limit 1.7 per 28 days
Humana Value Rx Plan (PDP)$4.30/mo premium · $601.00 deductible	5Specialty Tier	26%	—	$2017.9306	$4,035.862 units	Prior authorization Quantity limit 1.7 per 28 days
HealthSpring Assurance Rx (PDP)$32.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1906.6053	$3,813.212 units	Prior authorization Quantity limit 1.7 per 28 days
HealthSpring Extra Rx (PDP)$66.60/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1907.7632	$3,815.532 units	Prior authorization Quantity limit 1.7 per 28 days
Humana Premier Rx Plan (PDP)$108.60/mo premium · $0.00 deductible	5Specialty Tier	33%	—	$2017.9306	$4,035.862 units	Prior authorization Quantity limit 1.7 per 28 days

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.

See coverage in all 39 regions →