XGEVA 120 mg/1.7mL Injection

Also known as Denosumab. Coverage in Ohio (CMS PDP Region 14).

5 of 10 stand-alone Part D plans in Ohio cover this drug on tier 5.

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

45 Medicare Advantage plans in OH 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. OH: 45 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%	—	$1966.5529	$3,933.112 units	Prior authorization Quantity limit 1.7 per 28 days
Humana Value Rx Plan (PDP)$23.70/mo premium · $601.00 deductible	5Specialty Tier	26%	—	$1966.5529	$3,933.112 units	Prior authorization Quantity limit 1.7 per 28 days
HealthSpring Extra Rx (PDP)$65.70/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1851.5124	$3,703.022 units	Prior authorization Quantity limit 1.7 per 28 days
HealthSpring Assurance Rx (PDP)$109.50/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$1852.1509	$3,704.302 units	Prior authorization Quantity limit 1.7 per 28 days
Humana Premier Rx Plan (PDP)$117.60/mo premium · $0.00 deductible	5Specialty Tier	33%	—	$1966.5529	$3,933.112 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 →