XGEVA 120 mg/1.7mL Injection

Also known as Denosumab. Coverage in Michigan (CMS PDP Region 13).

5 of 12 stand-alone Part D plans in Michigan cover this drug on tier 5.

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

32 Medicare Advantage plans in MI 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. MI: 32 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	5Specialty Tier	25%	—	$1859.9243	$3,719.852 units	Prior authorization Quantity limit 1.7 per 28 days
Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1997.7854	$3,995.572 units	Prior authorization Quantity limit 1.7 per 28 days
Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible	5Specialty Tier	26%	—	$1997.7854	$3,995.572 units	Prior authorization Quantity limit 1.7 per 28 days
HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1860.1148	$3,720.232 units	Prior authorization Quantity limit 1.7 per 28 days
Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible	5Specialty Tier	33%	—	$1997.7854	$3,995.572 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 →