Denosumab – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers denosumab products: Prolia/Jubbonti/Stoboclo for postmenopausal osteoporosis, glucocorticoid‑induced osteoporosis, and to increase bone mass in patients on ADT or aromatase inhibitors, and Osenvelt/Wyost/Xgeva for prevention of skeletal‑related events in metastatic disease (with other FDA‑labeled oncology uses), while explicitly listing several unproven/not medically necessary uses (e.g., combination with IV bisphosphonates, general osteopenia, osteogenesis imperfecta, hyper‑parathyroidism, cancer pain, immobilization hypercalcemia, etc.). Authorizations are limited to 12 months with FDA‑consistent dosing; many indications require documentation of diagnosis, prior failure/intolerance/contraindication to oral and/or IV bisphosphonates, age or skeletal‑maturity criteria, expected survival ≥3 months for SRE prevention, specific lab thresholds for hypercalcemia (>12.5 mg/dL corrected), and reauthorization requires documented positive clinical response.