Denosumab Products (Prolia, Jubbonti) non-oncology

Denosumab (Prolia, Jubbonti) is covered only for non‑oncology, FDA‑approved indications—postmenopausal osteoporosis at high fracture risk, osteoporosis in men at high fracture risk, and glucocorticoid‑induced osteoporosis for patients on ≥7.5 mg/day prednisone equivalent expected ≥6 months—and oncology uses are excluded. Approval requires diagnostic evidence (osteoporotic/fragility fracture or T‑score ≤ −2.5, or T‑score −1.0 to −2.5 with high fracture risk), meeting one prior‑therapy criterion (12‑month oral bisphosphonate failure/intolerance/inability, prior IV bisphosphonate, prior fracture, or CrCl <30 mL/min with MBD evaluation), dosing 60 mg SC every 6 months, 12‑month authorizations, and reauthorization requires documented clinical benefit (stability, reduced vertebral fractures, or increased BMD) with continued glucocorticoids for GIOP.

"Treatment of postmenopausal women with osteoporosis at high risk for fracture (defined as a history of osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or a..."