Key takeaways:
Xgeva (denosumab) is an injectable medication used to prevent bone complications from cancer that has spread to the bones. It also treats high calcium levels caused by cancer.
Many commercial insurance, Medicare, and Medicaid plans cover Xgeva. But prior authorization is often required. And some plans may prefer an Xgeva biosimilar — a highly similar product that may cost less.
Without insurance, Xgeva can cost several thousand dollars per dose. But copay savings cards, patient assistance programs, and other discounts can reduce how much you pay. You can also ask your cancer care team about lower-cost biosimilars.
Xgeva (denosumab) is an injectable medication that helps lower the risk of serious bone problems in people whose cancer has spread to their bones. It also treats high calcium levels caused by cancer. Xgeva works by blocking a protein called RANK ligand, which triggers bone breakdown.
Xgeva can be an important part of cancer care, helping to protect your bones and lower the risk of complications. But you may face high out-of-pocket costs, especially if you don’t have insurance or are underinsured. Here’s what to know about the cost of Xgeva and ways to make your treatment more affordable.
How much does Xgeva cost?
Without insurance or discounts, one vial of Xgeva 120 mg costs an average of $4331.90. This dose is given every 4 weeks. But some people may receive additional doses on days 8 and 15 during their first month of treatment.
Xgeva is administered as a subcutaneous (under-the-skin) injection by a healthcare professional in a medical setting. Because it’s a specialty medication, Xgeva is dispensed through a specialty pharmacy that coordinates delivery. The pharmacy will send it directly to where you receive your injections or, in some cases, to your home so you can bring it to your appointment. Your cancer care team will tell you how to access Xgeva in preparation for your appointments, if needed.
What factors affect the cost of Xgeva?
Several factors can affect how much you pay for Xgeva, including:
Insurance coverage: Whether Xgeva is covered under your plan’s medical or pharmacy benefit can affect how much you pay. If you have Medicare, Xgeva is covered under Medicare Part B.
Healthcare setting: Since Xgeva is administered in a healthcare setting, administration or facility fees may be billed in addition to the medication cost.
Dose frequency: Most people receive Xgeva every 4 weeks. But you may get a few additional doses during your first month of treatment.
Pricing contracts: Prices may differ among hospitals, specialty pharmacies, and oncology clinics depending on negotiated rates.
Manufacturer support: Amgen, the maker of Xgeva, offers financial assistance programs that can reduce costs for those who are eligible.
Does insurance cover Xgeva?
Many commercial insurance, Medicare, and Medicaid plans cover Xgeva. But coverage policies can differ. In many cases, your prescriber will need to submit prior authorization to confirm that Xgeva is medically necessary for you. Some plans also require step therapy, meaning you may need to try another treatment first.
How different insurance plans cover Xgeva
The table below breaks down the percentage of enrollees who have coverage for Xgeva by insurance type. It also shows the likelihood of having prior authorization and step therapy requirements.
Insurance type | Enrollees covered for Xgeva | Enrollees required to get prior authorization | Enrollees required to do step therapy |
|---|---|---|---|
51% | 48.5% | 22.7% | |
Commercial plans (excluding ACA plans) | 72.4% | 55.7% | 6% |
Medicare (original Medicare and Medicare Advantage plans) | 75.4% | 57.3% | 27.7% |
Medicaid, including state-run and managed care plans | 70.4% | 59.4% | 7.9% |
Source: Managed Markets Insight & Technology, LLC™, as of September 11, 2025 (See methodology below.)
If your insurance doesn’t cover Xgeva, try these options:
Check savings program eligibility. Amgen offers copay assistance for people with commercial insurance and a patient assistance program for those who are uninsured or underinsured.
Talk to your prescriber about biosimilars. If your plan doesn’t cover Xgeva, it may cover one of its biosimilars instead. These biosimilars are highly similar to Xgeva but may cost less.
Request a formulary exception. Your prescriber can submit a formulary exception request to your insurance plan. This process includes providing documentation explaining why the medication is medically necessary for your condition. You have the right to file an appeal if the request is denied.
Compare plans during open enrollment. If you have the opportunity to change insurance plans, review your options during open enrollment. Plans differ in how they cover biologics and biosimilars. So, selecting one that covers Xgeva or a biosimilar version could lower your future costs.
Ways to save on Xgeva
Xgeva can cost thousands of dollars every month, especially if you don’t have insurance or your coverage is limited. Here are five ways to save:
Xgeva dosage guide: Learn about typical Xgeva (denosumab) dosages and what to do if you miss your injection appointment.
Preventing bone problems: Get the facts on why bone-modifying medications such as Xgeva are used in breast cancer treatment.
Making the switch: Wondering if switching to an Xgeva biosimilar is right for you? Here are key questions to ask your pharmacist.
1. Use a GoodRx coupon
Xgeva is a specialty medication administered in a medical setting. But it’s still worth checking the GoodRx website or app for potential savings at participating specialty pharmacies.
With GoodRx, the price of Xgeva is as low as $3486.84 for one 120 mg vial. You can also compare prices for Xgeva biosimilars, such as Bilprevda (denosumab-nxxp), which may be available at a lower cost. More on biosimilars later.
2. See if you qualify for a copay savings card
Amgen offers the Amgen SupportPlus Co-Pay Program to help make Xgeva more affordable. If you have commercial (private) insurance, you could pay as little as $0 for Xgeva through the program. You can enroll online or by calling 1-866-264-2778. Keep in mind that the program savings don’t apply to medication administration costs.
3. Check if you’re eligible for a patient assistance program
If you don’t have insurance, the Amgen Safety Net Foundation provides Xgeva at no cost to eligible people who meet income and residency requirements. Call 1-866-264-2778 to see if you qualify.
You can also look into independent patient assistance programs, such as the HealthWell Foundation. If the program is closed to new enrollees, you may be able to join a waitlist or sign up for alerts.
4. Tap into your HSA, FSA, or HRA
If you have a health savings account (HSA), flexible spending account (FSA), or health reimbursement arrangement (HRA), you can use those pretax funds to cover Xgeva or biosimilar copays, coinsurance, or related medical expenses. Just be sure to keep your receipts and any itemized statements.
5. Ask about biosimilars
Xgeva is a reference (brand-name) biologic — a medication made using living systems, such as animal cells. Instead of generics, biologics such as Xgeva have biosimilars, which are highly similar products that may cost less. There are several FDA-approved Xgeva biosimilars, including:
Xtrenbo (denosumab-qbde)
Aukelso (denosumab-kyqq)
Bilprevda
Bomyntra (denosumab-bnht)
Osenvelt (denosumab-bmwo)
Xbryk (denosumab-dssb)
Wyost (denosumab-bbdz)
Some insurance plans may prefer certain biosimilars over Xgeva. And in some cases, you may not need a new prescription to make the switch. Talk to your healthcare team about your options.
The bottom line
Xgeva (denosumab) is an injectable medication that helps prevent serious bone problems and treat high calcium levels in certain people with cancer. But without insurance or other discounts, one dose of Xgeva 120 mg costs an average of $4331.90.
Many commercial insurance, Medicare, and Medicaid plans cover Xgeva. However, prior authorization may be required. And in some cases, plans may prefer highly similar products to Xgeva called biosimilars instead.
If you’re looking for ways to make Xgeva more affordable, several savings opportunities are available. Ask your cancer care team about copay savings cards, patient assistance programs, and other discounts that can lower how much you pay.
Why trust our experts?
Methodology
We obtained national prescription coverage data for each medication from Managed Markets Insight & Technology (MMIT). The data reflects health insurance coverage as of September 2025.
We calculated the percentage of enrollees in plans that cover each medication by dividing the number of enrollees covered for the medication within a specific insurance channel (e.g., ACA, Medicare, Medicaid) by the total number of enrollees in all plans within that channel.
We determined the percentage of enrollees in plans with a prior authorization requirement by calculating the proportion of enrollees in plans that required prior authorization for the medication within each channel.
Finally, we measured the percentage of enrollees in plans with a step therapy requirement by calculating the proportion of enrollees in plans that imposed step therapy requirements for the medication in each channel.
These estimates, derived from national MMIT coverage data, provide insight into health insurance coverage for each medication. They take into account restrictions such as prior authorization, step therapy, and quantity limits. The percentages are expressed relative to the total number of enrollees covered by various insurance channels, including ACA plans, commercial (excluding ACA) plans, Medicare, and Medicaid (both state-run and managed care plans).
References
Amgen. (2025). Xgeva- denosumab injection [package insert].
Amgen Support. (n.d.). Amgen SupportPlus Co-Pay Program.
Amgen Support. (n.d.). Financial support.
Amgen Support. (n.d.). How to use the Amgen SupportPlus Co-Pay Program.
HealthWell Foundation. (n.d.). Bone metastases - Medicare Access.
Medicaid.gov. (n.d.). Managed care.
Medicare.gov. (n.d.). Prescription drugs (outpatient).
UnitedHealthcare. (2025). Medicare plans: Prolia and Xgeva replaced by 2 interchangeable biosimilars.
U.S. Food and Drug Administration. (2025). Biosimilar product information.
