Medicare Part D coverage · 1 · RxCUI 993456
1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia]
Per the CMS 2026 Part D formulary file, 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] is covered by 2,206 Medicare Part D plans (43.7% of enrollable products), averaging Tier 3.5, with prior authorization required on 18.1% of covering formularies.
- 43.7%
- Plan coverage
- 2,206
- Plans covering
- T3.5
- Avg tier
- 18.1%
- Prior auth required
What the CMS Formulary Data Shows for 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia]
Per the CMS 2026 Part D formulary file, 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] (RxNorm concept RXCUI 993456, generic name 1) appears on 94 distinct formulary files spanning 2,206 Medicare Part D plan offerings - 43.7% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.5.
Real-world access to 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] depends on utilization management as much as tier placement: 18.1% of covering formularies require prior authorization. 0% require step therapy. 93.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 255,565 Part D beneficiaries filled 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] in 2023, with total plan-and-beneficiary spending of $673,286,887 and an average per-beneficiary annual cost of $2,634.50. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] today.
Coverage Details
- Formularies covering
- 94
- Plans covering
- 2,206
- Coverage rate
- 43.7%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 18.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 93.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 255,565
- Total spending
- $673,286,887
- Avg per beneficiary
- $2,634.50
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | No | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | No | $0 | DE |
Show the next 30 plans
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] covered by Medicare Part D?
Yes, 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] is covered by 2,206 Medicare Part D plans (43.7% of all Part D formularies).
What tier is 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] on Medicare Part D plans?
1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] averages Tier 3.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] require prior authorization?
18.1% of Part D formularies require prior authorization for 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia]. Step therapy: 0%. Quantity limits: 93.6%.
How much does Medicare spend on 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia]?
In 2023, total Medicare Part D spending on 1 ML denosumab 60 MG/ML Prefilled Syringe [Prolia] was $673,286,887, covering 255,565 beneficiaries. The average spend per beneficiary was $2,634.50.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- lomustine 40 MG Oral Capsule T3.5
- tretinoin 0.001 MG/MG Topical Gel T3.5
- ethacrynic acid 25 MG Oral Tablet T3.5
- daridorexant 25 MG Oral Tablet [Quviviq] T3.5
- 24 HR canagliflozin 150 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Invokamet] T3.5
- canagliflozin 150 MG / metformin hydrochloride 1000 MG Oral Tablet [Invokamet] T3.5
Similar prior-authorization rate
- eszopiclone 3 MG Oral Tablet 18.2% PA
- betaine 1000 MG Powder for Oral Solution 18.2% PA
- tretinoin 10 MG Oral Capsule 18.3% PA
- promethazine hydrochloride 12.5 MG Rectal Suppository 18.3% PA
- penicillamine 250 MG Oral Capsule 17.9% PA
- zaleplon 10 MG Oral Capsule 18.4% PA