XGEVA 120 mg/1.7mL Injection

Also known as Denosumab. Coverage in New Jersey (CMS PDP Region 04).

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

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

13 Medicare Advantage plans in NJ 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. NJ: 13 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)$4.40/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1987.4201	$3,974.842 units	Prior authorization Quantity limit 1.7 per 28 days
Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible	5Specialty Tier	26%	—	$1987.4201	$3,974.842 units	Prior authorization Quantity limit 1.7 per 28 days
HealthSpring Extra Rx (PDP)$59.90/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1883.5464	$3,767.092 units	Prior authorization Quantity limit 1.7 per 28 days
HealthSpring Assurance Rx (PDP)$109.30/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1882.9937	$3,765.992 units	Prior authorization Quantity limit 1.7 per 28 days
Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible	5Specialty Tier	33%	—	$1987.4201	$3,974.842 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 →