Drug IndexProlia (denosumab)



Billing

Code: J0897

Description: Denosumab injection

Unit: 1 MG

Payment: $25.189

Pay quarter: Q2 2024


Covered in Part D: Yes

Avg tier level: 4


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

$1,736.63

Total Reimbursement:

$1,511.34

(ASP: $1,425.79, Margin: $85.55)

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# Units to bill:

60

Dosage & Frequency

Osteoporosis

• 60mg SQ every 6 months


Billable NDCs

55513-0710-01

Prolia (AMGEN USA, INC.)

60 MG


55513-0730-01

XGEVA (AMGEN USA, INC.)

120 MG



Prior Authorization

Aetna

United Healthcare

Anthem

Cigna


Resources

Drug Enrollment Form

Website