Prolia Insurance Form

Prolia is a prescription medicine used to increase bone mass in men with osteoporosis who are at high risk for fracture.

Prolia insurance form. However there is a generic form of reclast available called zoledronic acid. 1 844 268 7263 for other lines of business. Nearly 77 of medicare part b prolia patients have supplemental insurance and pay 0 out of pocket every six months. Insurance verification and prior authorization form fax with copies of insurance card s front and back.

Provider forms guides easily find and download forms guides and other related documentation that you need to do business with anthem all in one convenient location. Prolia denosumab. Open to patients with a prolia denosumab prescription and commercial insurance for prolia patients may not seek reimbursement for value received from the prolia co pay program from any third party payers including a flexible spending account or healthcare savings account. Primary insurance information if you have any questions please contact amgen assist asterisk fields are required for processing.

Medicare form prolia xgeva denosumab injectable medication precertification request page 2 of 3 all fields must be completed and legible for precertification review for medicare advantage part b. Prior to transmittal of any personal health information phi obtain the legally required patient authorizations for verification services. The remaining 23 of medicare part b prolia patients pay up to 212 99 out of pocket every six months depending on the patient s selected part b plan. These data do not include out of pocket costs related to office.

This program is not open to uninsured patients or patients receiving prescription. Prolia is a prescription medicine used to treat osteoporosis in men and women who will be taking corticosteroid medicines such as prednisone for at least six months and are at high risk for fracture. Insurance act which is a crime and subjects such person to criminal and civil penalties. Patients pay for prolia twice per year.

There is currently no generic form of prolia. Please see indications and important safety information on page 2 and the accompanying prolia full prescribing information including medication guide. The plan may request additional information or clarification if needed to evaluate requests. A generic drug is an exact copy of the active drug in a brand name.

Or patients who have failed or are. Prolia is indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture defined as a history of osteoporotic fracture or multiple risk factors for fracture.