Specialty Drug
DENOSUMAB (den oh sue mab) slows bone breakdown. Prolia is used to treat osteoporosis in women after menopause and in men. Xgeva is used to prevent bone fractures and other bone problems caused by cancer bone metastases. Xgeva is also used to treat giant cell tumor of the bone. Compare RANKL inhibitors.

Xgeva Medicare Coverage

Overview

Does Medicare cover Xgeva?

Yes.
94% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Xgeva co-pay with Medicare?

It depends. Which coverage stage are you in? Click on a tab below…

Deductible
Typical
Donut Hole
Post-Donut Hole
Co-Pay Range
$1840 – $2212
In the Deductible co-pay stage, you are responsible for the full cost of your prescriptions. Your Medicare deductible cannot exceed $360 in 2016.
Co-Pay Range
$460 – $710
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$828 – $996
In the Donut Hole (also called the Coverage Gap) stage, you’ll pay more for your prescriptions. In 2016, the Donut Hole begins once you’ve spent $3,310 in one year.
Co-Pay Range
$15 – $111
In the Post-Donut Hole (also called Catastrophic Coverage) stage, Medicare will cover most of your drug costs. In 2016, this stage begins once you have spent $4,850.
Want an exact price for your co-pay?

Ways to Save on Xgeva

Here are some ways that may lower the cost of your Xgeva prescription.

Manufacturer Coupon
Pay as little as $0 for your first fill and $25 for each refill, with insurance.
Patient Assistance Program
Receive your prescription at no cost if you are eligible.
Patient Assistance Program
Call to get more information on how they can financially assist you with your prescription.

Find Your Xgeva Medicare Co-Pay

Here are average co-pays for some of the most popular Medicare plans. Be sure to add your plan to see your specific co-pay. If a price is shown in red, GoodRx has found discount prices that are lower than your Medicare co-pay.

Average Co-Pay for 1 vial (1.7ml) of Xgeva 120mg/1.7ml

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $546
AARP MedicareComplete Plan 1 (HMO) $572
AARP MedicareComplete SecureHorizons (HMO) $533
AARP MedicareRx Preferred (PDP) $632
AARP MedicareRx Saver Plus (PDP) $493
Aetna Medicare Rx Saver (PDP) $500
Cigna-HealthSpring Preferred (HMO) $609
Cigna-HealthSpring Rx Secure (PDP) $493
Cigna-HealthSpring Rx Secure-Extra (PDP) $533
EnvisionRxPlus Silver (PDP) $496
Express Scripts Medicare - Value (PDP) $502
First Health Part D Value Plus (PDP) $660
Humana Enhanced (PDP) $652
Humana Preferred Rx Plan (PDP) $494
Humana Walmart Rx Plan (PDP) $493
Kaiser Permanente Senior Advantage (HMO) $695
MedicareBlue Rx Standard (PDP) $503
SilverScript Choice (PDP) $662
Symphonix Value Rx (PDP) $492
WellCare Classic (PDP) $505
Don't see your Medicare plan above?

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Xgeva Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

Some Medicare plans have restrictions on coverage of Xgeva that may include:

Prior Authorization

Most Medicare plans will require you to obtain their authorization before they will provide coverage for this prescription. You’ll need to contact your plan and they may require you to have your doctor fill out paperwork indicating why you need this prescription. If you do not receive authorization or don’t want to go through this process, you may want to consider using a GoodRx discount instead of Medicare to find the best price for this prescription.

What drug tier is Xgeva typically on?

Tier 5

Medicare plans typically list Xgeva in Tier 5 of their formulary. Tier 5 drugs are usually non-preferred brand-name drugs. Tier 5 drugs cost more than Tier 1, 2, 3 and 4 drugs.

Does your plan have restrictions?

See discount prices that can save you money when your Medicare plan doesn't work for you.

Medicare prices are provided by the Centers for Medicare and Medicaid Services (CMS). If you encounter any issues, please let us know.
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