Denosumab (Prolia)

Prolia (denosumab) is covered only for FDA‑approved non‑oncology indications—postmenopausal osteoporosis, osteoporosis in men, and glucocorticoid‑induced osteoporosis—and non‑approved/off‑label or oncology uses are not covered. Approval requires serum calcium above the lab lower limit, evidence of high fracture risk (fragility fracture OR specified BMD/FRAX thresholds or multiple risk factors), and if no prior fragility fracture either documented bisphosphonate failure or intolerance/contraindication to oral AND IV bisphosphonates (e.g., CrCl <35 mL/min); dosing 60 mg SC every 6 months and authorization limited to 12 months, with glucocorticoid‑induced osteoporosis requiring ≥7.5 mg/day prednisone (or equivalent) for ≥6 months.

"Treatment of osteoporosis in postmenopausal women"

Sign up to see full coverage criteria, indications, and limitations.